Research Project

UNIVERSITY OF EASTERN AFRICA, BARATON
SCHOOL OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH.
RESEARCH PROJECT.
DETERMINANTS OF COMPLIANCE TO HAND
HYGIENE IN EARLY CHILDHOOD CENTRES
WITHIN CHEMUNDU LOCATION.
A PROPOSAL DONE IN PARTIAL FULLFILLMENT OF THE COURSE
PHHC-496 RESEARCH PROJECT
BY:
STUDENT NAME: THELMA MWENI
STUDENT ID NO.:STHEMW1811
SUPERVISOR: MR.KHOL HELMUT
COURSE CO-ORDINATOR: MR. OLOUCH EVANCE.
28TH JULY 2021.

4th April 2021
DECLARATION
I, Thelma Mweni, hereby declare that this research proposal is my own original work and has
never been done or submitted to any university in partial fulfilment of the requirements for an
undergraduate or postgraduate degree program.
STUDENT’s NAME: THELMA MWENI STUDENT ID: STHEMW1811
STUDENT’S SIGNATURE: …………………… DATE: ………………………
SUPERVISOR’S NAME: MR: KHOL HELMUT
SUPERVISOR’S SIGNATURE: ………………. DATE: ……………………….
COURSE COORDINATOR’S NAME: MS ASENATH NYANTIKA- BARONGO
COURSE CORDINATOR’S SIGNATURE: ……………… DATE: ………………..

ACKNOWLEDGMENT
First, I would like to express my sincere gratitude to the Heavenly father who has given
me guide, strength and courage all through this research.
My special gratitude goes to my course instructor Mr.Oluoch Evance, for total sacrifice
of time and all the efforts and dedications that she has made towards the achievement of my
project proposal. She has patiently worked with me on every step and never stopped giving me
words of encouragement and support in writing of this research proposal.
I would also like to give special appreciation to my research supervisor Mr. Khol Helmut
for his total commitment and total support in writing this research proposal. In a special way I
would also like to thank my guardian for the love, care and support, emotional, spiritual and
financial during this time. I also appreciate my fellow colleagues for their sincere prayers and
encouragements to me. May the good Lord always bless you all.
DEFINITION OF TERMS.
Determinant - it is a factor which decisively affects the nature or outcome of something.
Compliance – it is the state or fact of according with or meeting rules or standards.
Hand hygiene - Hand hygiene is a way of cleaning one’s hands that substantially reduces
potential pathogens which are harmful microorganisms on the hands.
Kindergarten - is a preschool educational approach usually from four to six years based on
playing, singing, practical activities such as drawing, and social interaction as part of the
transition from home to school.
Communicable diseases – These are diseases that can be transmitted from one person to
another.
Hand washing - it is the act of cleaning one's hands with soap and water to remove
viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to
the hands in order to prevent diseases.
Incidence – it is the occurrence of new cases of disease or injury in a population.
Caregivers - a family member or paid helper who regularly looks after a child or a sick, elderly,
or disabled person.
Behavior – it is the way in which a person behaves in response to a particular situation or

stimulus.
LIST OF ABBREVIATIONS.
DCC – Day Care Centres.
WHO – World Health Organization.
ECD – Early Childhood Development.
ECDE – Early Childhood Development Education.
WASH – Water, Sanitation and Hygiene.
IREC- Institutional Research and Ethics Committee.
SPSS- Statistical Package for Social Sciences.

LIST OF FIGURES.
Figure 1: showing the age of respondents.................................................................................................................40

Figure 2: showing the gender of the respondents......................................................................................................41
Figure 3showing the percent of ID number of students..........................................................................................43
Figure 4: showing the frequencies and percent of classes observed. .....................................................................44
Figure 6: showing the percent of ID number of students........................................................................................46
Figure 7: showing the frequencies and percent of classes observed. .....................................................................47
Figure 8: showing the percent of ID number of students........................................................................................48
Figure 9: showing the frequencies and percent of classes observed.......................................................................48
Figure 10: showing the frequency and percent of gender distribution..................................................................49
Figure 11: showing the aspects of hand washing that children are aware of........................................................63
Figure 12: showing the teachings that the teachers use...........................................................................................63
Figure 13: showing the hand washing routine..........................................................................................................64
Figure 14: showing availability of Handwashing station........................................................................................70
Figure 15: showing the quality of water...................................................................................................................76
Figure 16: showing who gives assistance to the children. ........................................................................................80
Figure 17: showing the time children are taught about hand washing..................................................................90
Figure 18: showing the frequency of soap................................................................................................................91
Figure 19: showing soap replacement. .....................................................................................................................92
Figure 20: showing the level of learning...................................................................................................................93
Figure 21: showing the subjects that hand washing is taught................................................................................94
Figure 22: showing hand washing celebration day..................................................................................................96
Figure 23: showing if the school has Hand Washing day........................................................................................96
Figure 24: showing Hand Washing Policies in the school.......................................................................................97
LIST OF TABLES.
Contents
DECLARATION.......................................................................................................................................2
ACKNOWLEDGMENT...........................................................................................................................3
DEFINITION OF TERMS........................................................................................................................4
LIST OF ABBREVIATIONS....................................................................................................................5
LIST OF FIGURES...................................................................................................................................6
LIST OF TABLES...................................................................................................................................10
1. CHAPTER ONE..............................................................................................................................17
INTRODUCTION...................................................................................................................................17
1.1. Background of the study..........................................................................................................17
1.2. Problem statement...................................................................................................................18
1.3. Justification of the research....................................................................................................19
1.4. Significance of the study..........................................................................................................22
1.5. Aim of the study.......................................................................................................................22
1.6. Specific objectives....................................................................................................................22
1.7. Research questions...................................................................................................................23
1.8. Hypothesis................................................................................................................................23
CHAPTER TWO.....................................................................................................................................24
LITERATURE REVIEW........................................................................................................................24
2.1 LITERATURE REVIEW..............................................................................................................24
2.1.1 BACKGROUND INFORMATION................................................................................24
2.1.2 LEVEL OF COMPLIANCE TO HAND WASHING....................................................25
2.1.3 ENVIRONMENTAL CONDITIONS FOR HAND WASHING COMPLIANCE.......26
2.1.4 SCHOOL ADMINISTRATIVE FACTORS & COMPLIANCE...................................27
2.2 THEORETICAL FRAMEWORK..........................................................................................31
2.3 CONCEPTUAL FRAMEWORK...........................................................................................34
CHAPTER THREE.................................................................................................................................36
3.1 Study design.............................................................................................................................36
3.2 Study population......................................................................................................................36
3.3 Study area.................................................................................................................................36
3.4 Sample size determination.......................................................................................................37
3.5 Sampling techniques................................................................................................................38
3.6 Data Collections Tools.............................................................................................................38
3.7 Pilot Study................................................................................................................................38
3.8 Data collection procedure........................................................................................................39
3.9 Data entry and management...................................................................................................39
3.10 Data Analysis............................................................................................................................39
3.11 Data Presentation....................................................................................................................39
3.12 Data dissemination...................................................................................................................40
3.13 Ethical consideration...............................................................................................................40
3.13.1 Ethical approval.............................................................................................................40
3.13.2 Confidentiality and anonymity.....................................................................................40
3.13.4 Privacy.............................................................................................................................41
3.14 Inclusion and Exclusion Criteria............................................................................................41
Inclusion criteria..................................................................................................................................41
CHAPTER 4: FINDINGS AND DISCUSSION.....................................................................................42
4.1. INTRODUCTION.....................................................................................................................42
4.2. DEMOGRAPHIC INFORMATION..........................................................................................42
DISCUSSION AND FINDINGS.............................................................................................................54
4.3. FINDINGS UNDER LEVEL OF COMPLIANCE TO HAND WASHING...............................54
4.3.1. DISCUSSION OF FINDINGS ON LEVEL OF COMPLIANCE TO HAND WASHING.69
4.4. FINDINGS UNDER ENVIRONMENTAL CONDITIOND FOR HAND WASHING
COMPLIANCE.....................................................................................................................................72
4.4.1. DISCUSSION OF FINDINGS UNDER ENVIRONMENTAL CONDITIONS FOR HAND
WASHING COMPLIANCE..............................................................................................................80
4.5. FINDINGS UNDER SCHOOL ADMINISTRATIVE FACTORS AND COMPLIANCE.........82
4.5.1. DISCUSSION OF FINDINGS UNDER SCHOOL ADMINISTRATIVE FACTOR AND
COMPLIANCE...............................................................................................................................102
CHAPTER 5: CONCLUSION AND RECOMMENDATION............................................................106
5.1. CONCLUSION........................................................................................................................106
5.2. RECOMMENDATION............................................................................................................107
BUDGET................................................................................................................................................108
WORKPLAN.........................................................................................................................................109
APPENDICES........................................................................................................................................111
APPENDIX 1: INFORMATION AND CONSENT FORM...........................................................111
APPENDIX 2: RESEARCH QUESTIONNAIRE...........................................................................113
RESEARCH QUESTIONNAIRE.........................................................................................................113
APPENDIX 3: OBSERVATIONAL CHECKLIST..........................................................................118
REFERENCES......................................................................................................................................128
1. CHAPTER ONE
INTRODUCTION
1.1. Background of the study.
Children attending kindergarten and early childhood centres are highly susceptible to
diseases. Moreover, school children are implicated consistently in the spread of communicable
diseases [CITATION Did01 \l 1033 ].
Studies report that as society faces increased threats regarding the spread of diseases
among children, the perceptions about hand hygiene are changing even at the village level. Years
ago, the very notion that children could learn how to maintain hand hygiene regularly was
unthinkable.[CITATION Han14 \l 1033 ]. Consequently, health risks to which humans are
exposed prove that good hygiene practice is essential. The spread of most new-world diseases,
like bird flu and swine flu, has been attributed to a lack of hygiene (Suresh B.A, 2010)
[ CITATION JKJ16 \l 1033 ]. Thus, the need for widespread sound hygiene practices for all
people that are beneficial. UNICEF recommends that hygiene lessons for schools will often
encourage students to practice safe hygiene practices thus ensuring achievement of proper
hygiene goals [CITATION Did01 \l 1033 ].
Hand hygiene through proper hand washing is the most straightforward, most effective
measure for preventing infections [CITATION San10 \l 1033 ][CITATION Did01 \l 1033 ]. Hand
hygiene prevents cross-transmission of microorganisms and reduces the incidence of health care-
associated infections.[CITATION Lis18 \l 1033 ]. The school forms a vital setting for health
promotion and sensitization and thus caregivers in school play a pivotal role in the compliance of
hand washing. [CITATION Did01 \l 1033 ].

Regular hand washing is a cheap and effective way to reduce communicable disease
incidence and related child mortality in developing countries. (Burns, 2018). Especially, hand
washing with soap is an essential means of preventing acquired infections. (Pittet, 2001).
However, compliance with hand hygiene guidelines is generally low [CITATION Lis18 \l
1033 ] .
In order to develop successful interventions to improve hand hygiene compliance and
reduce gastrointestinal and respiratory infections among children attending day-care and primary
schools, it is necessary to assess the key determinants that underlie hand hygiene behaviour.
Interventions targeting these determinants can then get developed and evaluated.[CITATION
Jus18 \l 1033 ]
Therefore, the purpose of this study is to assess hand washing compliance of children
attending early childhood centres within Chemundu Location.
1.2. Problem statement.
The increasing burden of communicable diseases among early childhood centre children
and primary school children is due to poor personal hygiene practices and inadequate sanitary
conditions therefore this remains a concern on the public health agenda especially in developing
countries. Moreover, compliance with hand hygiene guidelines is generally low. Besides, school
children are particularly vulnerable to the neglect of basic personal hygiene due to lack of
knowledge and practice [ CITATION Han14 \l 1033 ]. This lack of effective hand hygiene
practices often leads to acute gastrointestinal illness in elementary school-aged children.
Consequently, studies have reported the difficulty in translating interventions into
behavioural change among children. Besides, instilling a habit of regular hand washing in young
children continues to be a challenging task, especially in developing country contexts, where it is

in various studies that only 3–35% of individuals wash their hands at critical times. [CITATION
Jus18 \l 1033 ]
In addition, compliance with hand hygiene practices by children in a school or day-care
setting is estimated only to be around 50 percent, which is vastly undermining the efforts to stem
out gastrointestinal diseases. Many children fail to wash their hands because of several reasons
such as; ineffective education, improper workflow of hygiene centres, inadequate safety culture
that promotes hygiene, just to name a few. [ CITATION APH06 \l 1033 ]. Moreover, the average
hand-washing enforcement rate was 37.5% for the early childhood care facility [ CITATION
Vic10 \l 1033 ].
1.3. Justification of the research.
Previous studies done on adherence have been done among physicians and risk factors leading
to nonadherence to hand hygiene (Pittet, et al, 2004); It has been within the health care industry
among its health care workers (Allegranzi & Pittet, 2009; Pittet, 2001) and even considered the
role of religious faith and culture in compliance to hand hygiene (Allegranzi & Pittet, 2009).
Among health workers in paediatric unit (Scheithauer, et al, 2011; Larson, Albrecht & O’Keefe,
2005; Schneider,et al., 2009). Besides, studies have been done still in hospitals on compliance to
hand hygiene guidelines in hospital care (Erasmus, et al., 2010).
Other studies have been in the food service industry (Pellegrino, et al., 2015). Systematic reviews
and meta-analyses in hospital hand hygiene (Luangasanatip, et al., 2015). Patients and caregivers
hand hygiene (Busby, et al, 2015).
Studies among school going children have focused on efficacy of hand washing demonstration
(Goel & Chandrashekar, 2020). A recent study was done on Hand hygiene during COVID-19
(Chen, et al, 2020). An interventional study was done on mandatory scheduled hand washing and
its effectiveness to illness reduction (Nadrup-Bus, 2009). Another study focused on training
using education and use of fluorescent concretization in hand hygiene (Öncü, 2019). An
interventional study in schools focused on kindergarten teachers hand hygiene behaviour change
techniques (Liu, et al., 2019). Other study has been among caregivers and parents to children
perceptions affecting hand hygiene (Biezen, et al., 2019). In Bangladesh, a study was done on
hand hygiene knowledge and practice among university students (Sultana, et al, 2016). In India,
as study focused on teaching hand washing techniques (Rani, et al., 2021).
Most of these studies have been in Bangladesh (Sultana, et al, 2016); Thailand,(Luangasanatip, et
al., 2015); China (Liu, et al., 2019; (Chen, et al, 2020) ); Denmark ((Nadrup-Bus, 2009); India
(Goel & Chandrashekar, 2020; Rani, et al., 2021 ).Among UK and Spanish travellers to other
countries and reported hand hygiene (Lawson, et al, 2021). A review was done from several
developing countries on hand hygiene strategies used for diarrhoea and respiratory tract
infections reduction. (Mbakaya, Lee & Lee, 2017). Moreover, a study has sought to design an
educational framework for hand hygiene in schools (Appiah-Brempong, et al, 2018). On the
other hand, a systematic review was done on the hand hygiene and environmental-disinfection
interventions among children (Staniford & Schmidtke, 2020). In Tanzania, it is been among
health care facilities hand hygiene interventions (Wiednmayer, et al, 2020).
In Africa, studies have been in school children have been on hand hygiene practices in Ghana
(Monney, et al., 2014). Health workers in Uganda (Mugambe, et al, 2021); mothers of new-borns
and compliance to hand hygiene in Uganda (Harrison, et al, 2019). In Nigeria, it was done
among primary school children assessing their hand hygiene practice (Orji, et al., 2013) and
hospitals (Kuzu, et al., 2005). Among caregivers in day care centres in Brazil, on the use of
playful intervention in promoting hand hygiene among children. (Mendes, de Jesus Mateus &
Costa, 2020). A study in Bogota, Columbia, assessed hand washing behaviours among school
children (Lopez-Quintero, Freeman & Neumark, 2009).
Majority of previous studies in Kenya on hand hygiene compliance have been mainly among
health care workers (Maingi, 2015; Ngugi, Murila & Musoke, 2019; Ndegwa, et al, 2019;
Bedoya, et al, 2017). While those studies among school going children are varied. For instance, a
study was done on availability of water and soapy water in schools and hand washing after toilet
visit (Wichaidit, et al, 2019). Another study reported on the use of video surveillance on hand
hygiene behaviour versus use of in-person observations in studies of school children (Pickering,
et al, 2014). A study in a slum in Nairobi reported on the use of waterless hand sanitizer in
improving student hand hygiene (Pickering, et al, 2013).
Indeed this review shows that there are very few studies from Africa, East Africa, and Kenya on
compliance to hand hygiene among children attending early childhood centres. Therefore, this
study has been developed with the main purpose of determining the compliance of hand hygiene
among children in early childhood centres within Chemundu location.
1.4. Significance of the study.
The findings from this study will be used to raise awareness of hygiene by public health
officers within Nandi County and Chemundu location who oversee the early childhood centres.
The Ministry of Health will utilize the findings gotten from this study to develop
programs, policies and guidelines that will ensure compliance to hygiene by children in
childhood centres.
Moreover, the Ministry of Education will use the findings in ensuring that the school
environment will ensure compliance to hygiene and through school policies, guidelines and
programs that will reduce health risks that exist within the childhood centres.
Besides, the findings from this study will be used by the public health department in
developing programs that will assist early childhood centres in ensuring compliance to hand
hygiene through ensuring a supportive school environment.
1.5. Aim of the study.
To assess the determinants of compliance of children’s hand hygiene in early childhood centres
within Chemundu Location.
1.6. Specific objectives.
1. To find out the level of compliance to hand hygiene among children in early
childhood centres within Chemundu location.
2. To determine the environmental determinants associated with compliance of
children’s hand hygiene in early childhood centres within Chemundu location.
3. To determine the school administrative factors associated with compliance of
children’s hand hygiene in early childhood centres within Chemundu Location.
1.7. Research questions
a) What is the level of compliance to hand hygiene among children in early childhood
centres within Chemundu location.
b) What are the environmental determinants associated with compliance of children’s
hand hygiene in early childhood centres within Chemundu location.
c) What are the school administrative factors associated with compliance of children’s
hand hygiene in early childhood centres within Chemundu location.

1.8. Hypothesis
Null hypothesis
There are no determinants to compliance of children’s hand hygiene in early childhood centres
within Chemundu Location.
Alternative hypothesis
There are several determinants to compliance of children’s hand hygiene in early childhood
centres within Chemundu Location.

CHAPTER TWO
LITERATURE REVIEW
2.1 LITERATURE REVIEW
2.1.1 BACKGROUND INFORMATION
Hand hygiene is a health issue of significance among children and their caregivers (Sue
Cavill, 2016). Consequently, good hygiene is a group of habitual practices that need our attention
and should be instilled in children at an early age, indeed, as early as possible. (Curtis, 2009).
Hence, large scale hand washing promotion programs will need more rigor or intensity to
improve hand washing behaviour (Huang, 2012).
Hand hygiene at home, school and within our communities plays an essential role in
helping to reduce the spread of infectious diseases. However, there has been a steady decline in
promotion of hygiene practices in modern homes, mainly due to changing environments and
structures. Children are usually taught to wash their hands when they are young, but
reinforcements of hand washing by the environment these children are in, often decreases when
children reach school.
Studies have shown, that children in urban areas are more likely to practice proper hand
washing behaviour than children situated in rural areas. Where in the urban dwellers practice
hand hygiene more often than their rural counterparts. This numerous hand washing practices
among urban children is due to the high-level acceptance of national initiatives like Hand
Washing Day. (Galiani, 2013).
Reports show that getting children to wash their hands, which is usually the first line of
defence against the spread of many diseases, reduces the rate of infection significantly. On
whether pupils know proper hygiene practices, 45 (94%) indicate that they have taught their
pupils about the benefits of proper hygiene while only 3 (6%) declined (Pittet, 2001).
Therefore, compliance can be increased through, community and school-level
interventions which will work better for information dissemination than massive mass media
campaigns at reaching community members and improving hand washing behaviour in the rural
locales in developing countries (Galiani, 2013).
2.1.2 LEVEL OF COMPLIANCE TO HAND WASHING.

To increase adherence of the hand hygiene guidelines, especially when it comes to the
children together with their teachers, it is of significant factor to intervene for this target group.
We can do this through various methods, such as improving behaviour among the children. As
the WASH (2012) states children should frequently wash their hands after playing, before eating
and after using the toilets (Quires, 2014).
Moreover, a recent study indicated that hand hygiene compliance amongst elementary
aged children is 58% after using the washroom, except soap usage averages 28% for girls and
only 8% for boys. (Boshell, the importance of hand hygiene at home and school, 2017).
Children need teaching more often than not about the hand hygiene guidelines so as for
them to practice it naturally by themselves. It trickles down to the time one takes when washing
hands. Making sure there is a number of children who practice the rubbing of their hands in the
required time following all the steps given during the rubbing technique. The correct hand
washing technique should incorporate the following steps; Rubbing palm to palm; Rubbing palm
to back; Rubbing between fingers; Rubbing back of fingers; Thumb rubbing; Rubbing on top of
fingers; Washing wrists; Rinsing hands and lastly, Drying hands.

2.1.3 ENVIRONMENTAL CONDITIONS FOR HAND WASHING
COMPLIANCE.
To increase adherence of the hand hygiene guidelines, especially when it comes to the
children together with their teachers, we need to provide these children with facilities within
their reach. It means that the sinks, taps, and soaps should be available for use by the children.
(Quires, 2014). Consequently, good hand washing practices can be demonstrated if the hand
washing facilities are of high quality, and hand washing is part of the daily school routine.
(Mahmoud, 2006).
Moreover, studies have shown that hand washing behaviour increases after improving
environmental conditions, including the supply of paper towels, supply of alcohol-based
sanitizers and even the supply of soaps. The use of only paper towel facilities are significantly
associated with hand washing compliance, while the other conditions like alcohol based
sanitizers and soap were not significantly associated. This may be explained by the fact that
fabric towels can get wet and cold during the day if not replaced adequately. Studies also on the
DCC have reported that a negative association between hand washing compliance and the
number of children per caregiver and between hand washing compliance.
Therefore, there is need to provide clean, attractive facilities with gentle soap and
effective hand drying options, as well as facilities in classrooms so that children and their
caregivers do not have to travel long routes to maintain hand hygiene. The design of such
classrooms should incorporate such facilities. Therefore, resulting in the facilities being better
looked after and bringing appeal when put to use (Huang, 2012). Even though this is not the case
at schools with no precise educational intervention, they may demonstrate good hand washing
practices if the hand washing facilities are of high quality, and hand washing is part of the daily
school routine.[CITATION Ins06 \l 1033 ].

The school environment should ensure that health information is accessible in public
places. Such information should be made available in an eye-catching, uncomplicated, and
accurate fashion. Where appropriate, large posters, containing bright colours and well-chosen
messages of health and hygiene (WHO, 2011). Therefore, there is need for the use of reminders
and cues for action. Whereby stickers and posters displaying and illustrating the steps to take
when practicing hand hygiene are put up where the children quickly access them (Beth E. Scott,
2017).
2.1.4 SCHOOL ADMINISTRATIVE FACTORS & COMPLIANCE

School is the place where health education regarding essential aspects of hygiene,
environment, and sanitation, as well as social customs, is being imparted. Hygiene is a crucial
factor in school habitability. (Pittet, 2001). Consequently, the struggle to overcome non-
compliance will be an uphill task, and requires more interventions from local administration
(Huang, 2012).
 School Supervision program
Statistics show that individuals are known to change behaviour when they know they are
under scrutiny. Therefore, once there is the presence of observers or rather supervisors, it
subsequently stimulates the performance of the caregivers to encourage children to perform hand
hygiene. We, therefore, recommend random supervision activities to be carried out by teachers or
even health standard officers in these schools (Zomer , 2013).
 Health Information provision by school
It has been recommended that schools and ECDE centres need to portray poster messages
for the promotion of; Hand washing, use of refuse bins, care of toilet facilities, and Protection of
water supplies (Judy, 2016). Moreover, the WHO (2011) stresses that it is essential to make sure
that health information is accessible in public places. Such information should be made available
in an eye-catching, uncomplicated, and accurate fashion. Where appropriate, large posters,
containing bright colours and well-chosen messages of health and hygiene, should be displayed
in public places for the general education of the public (WHO, 2011).
 Health education programs
The first is that, on its own, the provision of information about the importance of hand
washing may be necessary but not sufficient to lead to improved health outcomes. (Mcquerrey,
2018). Therefore, influencing choices on hand washing through education, information and
awareness is necessary. Hence, the need to devise educational interventions to promote hand
washing in school settings is essential to improve knowledge and awareness about healthy hand
hygiene in order to reduce the spread of infections, school absenteeism and increase compliance
to hand washing (Chittleborough, 2012)
A child will be more likely to wash their hands when they understand how and why to do
it, therefore, the caregivers and the teachers are responsible in ensuring similar understanding
levels among the early childhood centre on how, when and why they should wash their hands.
Hand washing behaviours can be influenced by structural factors, including time provided,
opportunity and accessibility of high quality facilities. Engaging children in structures that
demonstrate and promote hand washing is vital. (Chittleborough, 2012). Consequently, learning
about the reasons why one requires to wash hands is necessary in encouraging hand washing.
Knowledge and awareness among the children and teachers are consistent with demonstrating
whether they understand germs and hand hygiene (Mahmoud, 2006).
Therefore, it is evident that positive attitudes towards upholding high levels of hand
hygiene contributes to the adherence of the guidelines by the children without necessarily having
strict supervision over them. It shows us how important it is to impart sufficient knowledge
concerning the vital aspects of hand washing practices at an early age. (Mathur, 2011)
 Information availability within the school
Implementing the use of reminders and cues for action also comes in handy. Whereby stickers
and posters displaying and illustrating the steps to take when practicing hand hygiene put up
where the children quickly access them. Teaching and singing hand washing songs with the
children to enable them to meet the hand washing standard. (Beth E. Scott, 2017).
The WHO (2011) stresses that it is essential to make sure that health information is accessible in
public places. Such information should be made available in an eye-catching, uncomplicated,
and accurate fashion. Where appropriate, large posters, containing bright colours and well-
chosen messages of health and hygiene, should be displayed in public places for the general
education of the public. Schools and ECDE centres need to portray poster messages for the
promotion of; Hand washing, use of refuse bins, care of toilet facilities, and Protection of water
supplies.
 Promoting hygiene through Clubs, curriculum, educational activities and Incentives
Moreover, a culture of hygiene in schools will work better to ensure adoption of proper hand
washing behaviour possibly through the use of hygiene clubs and providing incentives to
students that exhibit proper hygiene practices. Determination of the cues that students need to
help improve their behaviour and the information acquired from the school, will help shape
positive attitude towards proper behaviour. Hand washing can be integrated into the school
curriculum as well as invitation of school stakeholders to participate in educational activities that
lead to the promotion of proper hand washing hygiene. It will be competent to promote healthful
behaviours through the design of coherent and comprehensive school policies that deal with hand
washing hygiene.[ CITATION Lop09 \l 1033 ]
Educational programs are encouraged to target children making it more useful to achieve
behavioural change. Besides, many hand washing studies rely on self-reported measures of hand
washing behaviour, which may be subject to bias. Obtaining objectively verified observational
measures of hand washing is a challenge for any study of hand washing behaviour, with
proposed solutions such as direct observation.[CITATION Han14 \l 1033 ]

Key Variables
1. Independent Variable
 Environmental Factors
 School administration factors
2. Dependent Variable
 Level of compliance to hand washing hygiene.
2.2THEORETICAL FRAMEWORK
Social cognitive theory and social learning theories underpin this research study. Bandura’s
social cognitive theory predicts that the behaviour of a person is largely determined by the
interaction between environmental, behavioural, and personal influences (Lee et al. 2018). The
theory explains how environment affects behaviour. Also, the theory highlights the potential
abilities of individuals to change the environment to realize their goals. Social cognitive theory
underscores the role of self-efficacy in directly influencing the behaviour of an individual. On the
other hand, social learning theory is also lauded as a desirable element that promotes the
universally acceptable behavioural change (Nabavi, 2012). The theory posits that individuals
learn from the interactions with others and the environment. For instance, observing others
behaviours enables one to adopt similar behaviours. People tend to imitate observed behaviours
of others, especially when such behaviours result in positive outcomes or rewards.
Social cognitive and social learning theories may determine the level of compliance to hand
washing in the school setting. Social cognitive theory explains that the environment affects the
behaviour. Therefore, the environmental determinants of the availability of taps, clean water,
alcohol-based sanitizers, and sinks determine the level of hand washing compliance among
children. Further, social cognitive theory explains that individuals have an ability to alter the
environment to realize set goals. For instance, the school administration may initiate actions,
such as supervision, financing facilities, emphasis on hand washing, and health education
programs to enhance hand washing compliance. On the other hand, social learning theory argues
that observation of others’ behaviours may make an individual to adopt similar behaviours. For
instance, the school administration may need to demonstrate effective hand washing steps during
supervision and health education programs. As a result, children may adopt the behaviour,
especially when the importance of hand washing is emphasized during supervision and education
programs sessions.
Theoretical Model
Figure 1: Theoritical model
In figure 1 above, external variables, including availability of taps, clean water, alcohol-based
sanitizers, and sinks, as well as observations of hand washing procedures, supervising children to
observe hand washing guidelines, instituting financing approaches for hand washing, and
emphasising on hand washing may change the attitude of children and develop skills that support
hand washing. Also, attitude toward targets and personal characteristics of children inform their
norms and self-efficacy capabilities to change their view on hand washing. Environmental
constraints, including failure of the school administration to oversee the hand washing process
and lack of funds to manage and sustain hand washing equipment and materials may ultimately
affect the outcome of the hand washing programs in school.

2.3CONCEPTUAL FRAMEWORK
In figure 2 below, school administrative factors, including supervision, health education
programs, financing of facilities, monitoring hand washing and teacher emphasis on hand
washing are the independent variables that will ultimately change the perceptions of students on
why, when and how they wash hands. Consequently, any changes in the school administrative
factors would show the level of compliance of participants. The outcomes of the interventions
measures in relation to environmental factors will be categorized as low, moderate or high.
The conceptual model in fig. 2 below shows the correlation between environmental
factors, including the availability of sinks, clean water, alcohol-based sanitizers, and taps in the
school setting and level of compliance dependent variable. The changes in any of the
environmental variables will affect the level of hand washing compliance.

Independent Variable Dependent Variable
School administrative
factors
supervision
Health education programs
financing of facilities
Monitoring hand washing
Teacher emphasis of hand
washing
Level of compliance
Why students wash their
hands.
When do they wash their
hands
How do they wash their
hands
Environment
Determinants
Availability of sinks
Availability of clean
water
Availability of alcohol
based hand sanitizer
Availability of taps
Access points
Reachability or
accessibility
CHAPTER THREE
METHODOLOGY
3.1 Study design
The study will utilize a quantitative, descriptive, cross-sectional study design.
3.2 Study population
The population for this study will be children and teachers of early childhood centres within
Chemundu location. These are children aged between 3-7 years. The classes involved in the
study will be PP1, PP2 and Grade 1. A total of 11 schools exists in Chemundu
location.Chemundu is divided in two sub-location in Baraton sub-location the schools involved
are; Baraton primary, Baraton AIC, Baraton International school, Chemundu primary, Masaba
primary school, Samoo primary school and Father boyle’s. In Kapyagan they include Kapyagan
primary school, Kapkobis primary school, Berur primary school and Kaptidil primary
school.Two schools a private and public one will be selected that is, Baraton International School
with 85 students and Chemundu Primary school with 109 students respectively, summing up to a
total population of 194 students and 6teachers, 2 head teachers and 2 deputy head teachers.
3.3 Study area
The study will be carried out in Chemundu, it’s located in Baraton sub location, Chemundu
Location, Kapsabet Division, Nandi Central in Nandi County in the rift valley. It is located at an
elevation of 1,905 meters above sea level. Its coordinates are 0°13'60" N and 35°4'0" E in
Degrees Minutes Seconds or 0.233333 and 35.0667 in decimal degrees. It covers 4 kilometres
away from Kapsabet town and 2.3 km away from Baraton University. Chemundu covers 40
square kilometres.
It’s a rural setting where most people depend on tea farming, and animal keeping. The also
serves different functions, dispensaries for health services and a police post is located here.
3.4 Sample size determination
The study will focus on three different schools, and from each school students from different
classes will be involved in the study. The different classes, (PP1,PP2 and grade 1) represent
different subsets.The number of individuals involved in the study will be around 100.A total of
11 schools exists in Chemundu location.Out of the 11 schools 30% of the schools will be
sampled for the study where one will be used as the pilot study .Mugenda and Mugenda indicates
that the study sample size should be large to result to represent the characteristics of the target
population to an acceptable degree with 30% of the total population for the descriptive study.
nf, desired sample size( population not less than 10,000)
nf, desired sample size ( population more than 10,000)
30% *11 = 3.3 =4.
Out of the four schools, three schools will be involved in the study while one school will be
involved in the pilot study.
Propotionate stratified sampling will then be used to select the children in these 3 schools.
therefore, nf is equal to 30/100* 272 = 81
Aic Baraton Academy, 83 pupils
nf, equals 83/272*81 = 25
Chemundu Primary School, 109 pupils

nf, 109/272*81 = 32
3.5 Sampling techniques
Stratified sampling and purposive sampling techniques will be used in selection of a private
school and a public school from Chemundu Location. Purposive sampling technique will be
used to pick Chemundu Primary School as representative of public schools and Baraton
International School as a representative of the private schools. Then the children that will be
observed will be picked using systematic sampling technique. Where every nth number of the
pupils will be picked as they come to eat or as they visit the toilet and go back to class.
Then purposive sampling will be used among the teachers by picking the class teachers of the
classes, deputy head teachers and head teachers of the respective study schools.
3.6 Data Collections Tools
Data will be collected using a self-administered closed ended questionnaire and an observational
checklist.
3.7 Pilot Study
The pilot study will be carried out in Father Boyle Academy located at Baraton Shopping Centre.
With the sole aim of testing the reliability and validity of the research tools i.e. self-administered
closed ended questionnaire and observational checklist.
3.8 Data collection procedure
The study will commence after an approval from the institutional research ethics committee this
will ensure that the study will be based on ethical consideration. There will be an informed
consent which is a voluntary agreement to participate in research.it is not merely a form that is
signed but is a process in which the subject has an understanding of the research and its risks,
from the participants who meet the inclusion criteria. After approval then and self - administered
close-ended questionnaire will be administered to interact with the participants together with a
checklist. Permission will also be needed from the principles in the school, the area chief, the
education officer for Chesumei sub-county office and also permission from the teachers of the
class. The data will then be collected through observation.
3.9 Data entry and management
Data will be cleaned, coded then entered into Statistical Package for Social Sciences (SPSS)
version 25.
3.10 Data Analysis
Descriptive analysis of the data entered into SPSS will be done using measures of central
tendency (mean, mode and median), measures of spread (standard deviation, interquartile range,
variance).
3.11 Data Presentation
The data will be presented in form of tables, histograms, pie charts and bar graphs.
3.12 Data dissemination.
Findings from this study will be presented in seminars, workshops and conferences and bound
copies will be submitted to the county Ministry of Education Offices, the principals of the
schools studied, the public health offices of Nandi County, the public Health department of
UEAB and also posted to the webpage of the UEAB library. Besides, they will be published in
relevant public health journals.

3.13 Ethical consideration.
3.13.1 Ethical approval
Ethical approval will be sought from the Institutional Research and Ethics Committee of the
University of Eastern Africa, Baraton before going out to the field to collect data.
3.13.2 Confidentiality and anonymity
Privacy and confidentiality will be ensured to the participants since no names will be recorded in
the questionnaires. Voluntary withdrawal from the study at any time will be allowed without any
intimidation of the participant. The questionnaires shall be kept in the public health department
to ensure privacy.
3.13.3 Informed Consent and Voluntary Participation
Permission to conduct the study will be sought from the head teachers and from the parents of
pupils in the selected schools for the study. The purpose of the study will be explained to the
study participants so as to ensure informed consent before they accept to voluntarily participate
in the study. The participants are free to withdraw from the study or to refuse to be observed at
any time during the study.
3.13.4 Privacy
Privacy of the participants will be ensured in the study through ensuring that the questionnaires
will be kept under complete lock and key within the department of public health.
3.14 Inclusion and Exclusion Criteria
Inclusion criteria
The study will include class teachers, coordinators of Early Childhood Centres, and the children
in the early childhood centres in PP1, PP2 and Grade 1.

Exclusion Criteria
The study will exclude children whose parents will have refused to be observed and class
teachers and pupils in grade 2-4 and those in class 5 to 8. It will also exclude any visiting
teachers.
CHAPTER 4: FINDINGS AND DISCUSSION.
4.1. INTRODUCTION.
This chapter covers the discussion and findings of the qualitative data analysis. It as well present
findings on the analyses and provides an overview of the research findings obtained based on the
descriptive statistics for the measuring instruments which were used. The aim of the study was to
assess the determinants of compliance to hand hygiene in early childhood centers. This study
targeted 60 pupils and 10 teachers from which 46 pupils and all teachers took place in the study
making a response rate of 80%. According to Mugenda Mugenda (2002) a response rate of 50%
is enough for analysis and reporting whereas 60%- 69% is considered to be good and above 70%
is considered excellent.The data was obtained through the use of observational checklist and
questionnaires, it was analyzed and presented in the form of tables, bar graphs and pie charts.
4.2. DEMOGRAPHIC INFORMATION.
Figure 2: showing the age of respondents
Age.
10.00%10.00% 26_30 years

31_35 years
20.00%
36_40 years
30.00%
40_45 years
51_55 years
30.00%
This implies that majority of the teacher who took part in the study lie under the age of 36-
40(30%) and 40-45 (30%). 20% were under the age of 31_35 years, 10% under the age of 26_30
years and 10% under the age of 51_55 years.

Figure 3: showing the gender of the respondents.
Object 5
From the study, it’s clear that majority of the respondents were female (60%), whereas male were
around 40%. This implies that majority of the teachers in the school are females.
Table 1: showing the working period of the respondents.
Mean Media Mod Std. Variance Rang Minimu Maximu
n e deviatio e m m
n
School 7.700 7.5000 10.00 4.73873 22.456 16.00 2.00 18.00
working 0
period
The table above (table. 1) shows that most of the respondents have averagely worked for 8 years,
and the middle 8 years. The most appearing number of years of working is 10 years. The
minimum working period is 2 years while the maximum working period is 18 years.
Table 2: showing the classes handled by the respondents.
Frequency Valid Percent
Valid PP1 2 20.0
PP2 2 20.0
Grade 1 2 20.0
School 4 40.0
Administrator
Total 10 100.0
From the study, majority of the respondents were School administrators, 4 (40%), whereas the
teachers in PP1, PP2 and Grade 1 were 2% each. Therefore majority of the respondents included
the Head Teachers and Deputy Head Teachers. A teacher in each class that is in PP1, PP2 and
Grade 1.
OBSERVATIONAL CHECKLIST TEA BREAK.

Figure 3: showing the percent of ID number of students.
Object 7
Figure 4showing the percent of ID number of students.
Majority of the students observed by the researcher were Grade 1 students (39%), 37% were PP2
students and only 24% were PP1 students. This implies high number of students in grade one in
the facility and also the return rate of the consent form from their parents was high that allowed
the researcher to carry out the study among the students.

Figure 5: showing the frequencies and percent of classes observed.
CLASS.
45
40
39.1
35 37.0
30
25
23.9
20
15 17 18
10 11
5
0
PP1 PP2 Grade1
Majority of the students observed by the researcher were Grade 1 students (39.1%)who were 18,
37% were PP2 students who were 17 in number and only 23.9% were PP1 students who were 11.
This shows that grade one had the highest number of children who were observed facility and
also the return rate of the consent form from their parents was high that allowed the researcher to
carry out the study among the student.

Table 3: showing the frequencies and percentage of the respondent’s gender.
Female 24 52.2
Male 22 47.8
Total 46 100.0
Majority of the students who were involved in the study in the schools were females (52.2%),
whereas males were 47.8%. This implies that ladies are many in the school as compared to the
men.
YES
NO
Object 11
Figure 6: showing the percent of ID number of students.

Class.
39.1
37.0
23.9
17 18
11
PP1 PP2 Grade 1
carry out the study among the students.
Table 4: showing the gender of the respondents.
Frequency Percent
Female 24 52.2
Male 22 47.8
Total 46 100.0
men.
OBSERVATIONAL CHECKLIST TOILET BREAK.
Figure 8: showing the percent of ID number of students

Object 15

Object 17
carry out the study among the students.
Figure 10: showing the frequency and percent of gender distribution.
Object 20
men.
DEMOGRAPHICS INTRODUCTION.
In the study the respondents had different age groups, the youngest was 26 years while the oldest
was 55 years old, majority of the respondents (30%) indicated that they had stayed in their
respective schools for 10 years, in addition, 60% of the respondents were female, indicating
majority of the teachers in the lower primary were females. The study found no association
between gender and the working period of the respondents in the schools.
Majority of the pupils observed by the researcher were Grade 1 students (39%), 37% were PP2
students and only 24% were PP1 students. In addition to that the number of the students who
were involved in the study in the schools were females (52.2%), whereas males were 47.8%.
This implies that ladies are many in the school as compared to the men.
DISCUSSION AND FINDINGS.
4.3. FINDINGS UNDER LEVEL OF COMPLIANCE TO HAND
WASHING.
Table 5: showing the frequencies and percent of the different steps followed by students
during hand washing at toilet break
Frequency Percent
Usage of Soap
Yes 44 95.7
No 2 4.3
Forgot to use soap
Yes 2 4.3
No 44 95.7
No soap
No 46 100
Used hand sanitizer
No 46 100
Just wiped hands
No 46 100
Rubbing palm to palm
Yes 43 93.5
No 3 6.5
Rubbing palm to back
Yes 15 32.6
No 31 67.4
Rubbing between fingers
Yes 15 32.6
No 31 67.4
Rubbing back of fingers
Yes 6 13
No 40 87
Thumb rubbing
No 46 100
Rubbing on top of fingers
Yes 3 6.5
No 43 93.5
Washing wrists
No 46 100
Rinsing hands
Yes 45 97.8
No 1 2.2
Drying hands
No 46 100
The table above shows the steps on hand washing and how many children followed the steps and
the necessary items used during hand washing. During observation only 44 pupils (95.7%) used
soaps while 2 pupils (4.3%) forgot to use soap. Soaps and sanitizers were available in the schools
although the hand sanitizers were mostly available in the administration office. None of the
students wiped their hands and this is because none of the hand washing facilities had drying
materials. Majority of the pupils managed to rub palm to palm (93.5%) while 3 pupils did not rub
palm to palm (6.5%). When it came to rubbing palm to back and rubbing between fingers, 15
pupils (32.6%) followed the step. No pupils rubbed their thumbs, on the other hand 3 pupils
(6.5%) rubbed on top of fingers while 43 pupils (93.5%) missed the step. None of the pupils
washed their wrists, 97.8% pupils rinsed their hands. None of the children dried their hands. This
implies that the pupils lack enough knowledge on hand washing hygiene for majority of the
pupils do not follow the required steps of hand washing.
during hand washing at tea break
Frequency Percent
Usage of Soap
Yes 43 93.5
No 3 6.5
Forgot to use soap
Yes 3 6.5
No 43 93.5
No soap
No 46 100
Used hand sanitizer
No 46 100
Just wiped hands
No 46 100
Yes 42 91.3
No 4 8.7
Yes 15 32.4
No 31 67.4
Yes 13 28.2
No 33 71.8
Yes 40 87
No 6 13
Thumb rubbing
No 46 100
Yes 3 6.5
No 43 93.5
Washing wrists
No 46 100
Rinsing hands
Yes 45 97.8
No 1 2.2
Drying hands
No 46 100
Table 6 above shows the steps on hand washing and the number of children that followed the
steps and the necessary items used during hand washing. Soap is an essential item that is
mandatory when it comes to hand washing, from the study, 43 pupils (93.5%) used soaps while 3
pupils (6.5%) forgot to use soap. Soap was available as well as hand sanitizers. No wiping
material was available hence no student wiped their hands. Majority of the pupils rubbed palm to
palm (91.3%) while 15 pupils (32.6%) managed to rub palm to back. A number of pupils (28.2%)
rubbed between fingers although most pupils (71.8%) did not rub between fingers. Only 6 pupils
(13%) rubbed back of fingers as none of the pupils rubbed their thumbs. 3 pupils (6.5%) rubbed
on top of fingers while 43 pupils (93.5%) did not rub on top of fingers. None of the pupils
washed their wrists, 45 pupils (97.8%) rinsed their hands while one pupil (2.2%) did not rinse
his/ her hands. None of the children dried their hands. This shows that the pupils do not have
enough knowledge on hand washing hygiene for majority of the pupils do not follow the
required steps of hand washing.
during hand washing at lunch break
Frequency Percent
Usage of Soap
Yes 43 93.5
No 3 6.5
Forgot to use soap
Yes 3 6.5
No 43 93.5
No soap
No 46 100
Used hand sanitizer
No 46 100
Just wiped hands
No 46 100
Yes 42 91.3
No 4 8.7
Yes 15 32.4
No 31 67.4
Yes 13 28.2
No 33 71.8

Yes 40 87
No 6 13
Thumb rubbing
No 46 100
Yes 3 6.5
No 43 93.5
Washing wrists
No 46 100
Rinsing hands
Yes 45 97.8
No 1 2.2
Drying hands
No 46 100
Table 7 above shows the steps on hand washing and how many children followed the steps and
the necessary items used during hand washing. On usage of soap, 43 pupils (93.5%) used soaps
leaving behind 3 pupils (6.5%) who forgot to use soap. Soap was available as well as alcohol –
based hand sanitizers. None of the pupils wiped their hands they all used water. In addition to
that 42 pupils rubbed palm to palm (91.3%) as 15 pupils (32.6%) rubbed palm to back. Majority
(71.8%) of the pupils failed rub between fingers. 6 pupils (13%) rubbed back of fingers while 40
pupils (87%) did not rub back of fingers. None of the pupils rubbed their thumbs. 3 pupils (6.5%)
rubbed on top of fingers while 43 pupils (93.5%) did not rub on top of fingers. None of the
pupils washed their wrists, 45 pupils (97.8%) rinsed their hands while one pupil (2.2%) did not
rinse his/ her hands. None of the children dried their hands. This shows that the pupils do not
have enough knowledge on hand washing hygiene for majority of the pupils do not follow the
required steps of hand washing.
Table 8: showing the percentage and frequency of children who remember to wash hands
after visiting the toilet use
Mean Median Mode Std. Variance Range Minimum Maximum
deviation
Percentage 72.000 70.000 70.00 22.99758 528.889 80.00 20.00 100.00
of children
who
remember
to wash
hands after
visiting the
toilet.
The table above shows the average number of children who wash their hands after visiting the
toilet is 72%. The middle number of children being 70% and the most appearing percentage is
70%. The minimum being 20% and the maximum being 100%. This shows that a good number
of children wash their hands after visiting the toilet which is recommended.
before taking tea.
Mean Media Mod Std. Variance Range Minimu Maximu
n e deviatio m m
n
Before 63.000 80.0000 80.00 35.60587 1267.778 100.0 0.00 100.00
taking tea 0 0
before taking lunch.
Mean Media Mod Std. Variance Range Minimu Maximu
n e deviatio m m
n
Before 65.000 80.0000 80.00 35.66822 1272.222 100.0 0.00 100.00
taking 0 0
lunch
The table above shows the average number of children who wash their hands before taking lunch
is 65%. The middle number of children being 80% and the most appearing percentage is 80%.
The minimum being 0% and the maximum being 100%. This shows that a good number of
children wash their hands before taking lunch as it is recommended.
Table 11: Table showing the percentage and frequency of children who use soap to wash
hands
Mean Media Mode Std. Variance Rang Minimu Maximu
n deviatio e m m
n
To use 65.000 65.0000 50.00 16.49916 272.222 50.00 50.00 100.00
soap 0
The table above shows the average number of children who use soap when washing their hands
is 65%. The middle number of children being 65% and the most appearing percentage is 50%.
The minimum being 50% and the maximum being 100%. This shows that a good number of
children use soap when washing their hands which is important in order to kill bacteria.
Table 12: showing the percentage and frequency of children who follow all steps of
handwashing
Mean Media Mod Std. Variance Rang Minimu Maximu
n e deviatio e m m
n
Follow 52.000 50.0000 50.00 16.19328 262.222 50.00 20.00 70.00
all steps 0
of hand
washing
The table above shows the average number of children who follow the steps of hand washing
when washing their hands is 52%. The middle number of children being 50% and the most
appearing percentage is 50%. The minimum being 20% and the maximum being 70%. This
shows that a few number of children follow the steps on hand washing.
Figure 11: showing the aspects of hand washing that children are aware of.
Object 23
When to comes to hand washing, most of the respondents teach the children on why they should
wash hands (50%), when to wash hands (20%), steps in washing hands (20%) and 10% are not
aware of any aspects of hand washing. Therefore, majority of the respondents’ children are away
of why they should wash their hands.
Figure 12: showing the teachings that the teachers use
Object 25
This implies that the teachings that students are aware of are taught through demonstrations
(91%) and posters (9%). Therefore the level of knowledge to the kids on hand washing is clearly
as the demonstrations show on how they are supposed to wash hands.
Figure 13: showing the hand washing routine.

Object 27
The schools have a hand washing routine where the students mainly practice hand washing
before eating lunch as indicated by majority of the respondents (40%), 30% indicated the
practice is done before assembly and 10% indicated it was done after visiting the toilet,
immediately after break and also 10% indicated they did not have any hand washing routine.
This implies that students in the schools are expected to wash hands mainly before they take their
meals, as the teacher on duty supervises the activity.
Table 13: One sample T-test on Compliance Level (Lunch)
One-Sample Statistics
Std.
One-Sample Test
Test Value
Deviatio = 1.5
Std. Error
t do Sig. (2- Mean 95% Confidence Interval of
N Mean n Mean
Level of 46 1.7360tailed)
.05807 Difference
.00856 the Difference
Lower Upper
Level of
Compliance 27.568 45 .000 .23602 .2188 .2533
Compliance
Table 14: One sample T-test on Compliance Level (Tea)
Std. Std. Error
N Mean Deviation Mean

Compliance 46 1.7361 .05807 .00856
Level
One-Sample Test
Test Value = 1.5
95% Confidence Interval of
Sig. (2- Mean
the Difference
t df tailed) Difference Lower Upper
Compliance 27.567 45 .000 .23602 .2188 .2533
Level
Table 15: One sample T-test on Compliance Level (Toilet)
Std. Std. Error

Compliance 46 1.7314 .05468 .00806
Level
One-Sample Test
Test Value = 1.5
Sig. (2- Mean
the Difference
Compliance 28.699 45 .000 .23137 .2151 .2476
Level
4.3.1. DISCUSSION OF FINDINGS ON LEVEL OF COMPLIANCE TO
HAND WASHING.
In a study done by Yehuda (2005), it found that one third (33.6%) of the children observed
practiced proper hand-washing behavior such as washing hands ‘‘always’’ or ‘‘very often’’ with
soap and clean water before eating and after using the toilet. Only 3% of students, however the
criteria for Centres for Disease Control and Prevention definition, which includes always
washing hands for at least 20 seconds. In our study, the children were observed at different
intervals, during tea break, lunch time and during toilet breaks, where 93.5% of the students
observed used soap to wash hands, 6.5% forgot to use soap. Soap was available(100%) therefore
none of the students used hand sanitizer(100%). 91.3% of the students rubbed palm to palm,
where only 32.6% rubbed palm to back, 28.2% of the students rubbed between fingers,13%
rubbed back of fingers. None of the pupils neither rubbed their thumbs nor washed their wrists,
and only 97.8% rinsed their hands. During tea break, majority of the students observed were
females (52.2%), compared to male (47.8%). During the hand washing activity, majority of the
students adhered to rubbing of palm to palm (91, 3%) and usage of soap (93.5%). This findings
were also observed during toilet break, 95.7% of the students observed used soap, majority
adhered to rubbing between fingers (67.4%), rubbing palm to palm (93.5%) and rinsing of hands
97.5% only.
When the respondents were asked which aspects of hand washing the children are aware of, 50%
of the respondents indicate majority of the students are aware of why they should wash their
hands, where as 20% indicated students are taught on when and how they should wash their
hands. This therefore implies the reason as to why the children do not adhere to the different
steps in hand washing is due to the different understanding of the aspects taught to them. In
another study that was done by Marie (2020) which served to examine the immediate impact of
the handwashing song in a public space, the results showed that overall, young children’s
handwashing behavior improved after taking part in the song activity, washing in between the
fingers improved significantly (53% of participants did so in intervention group compared to
25% of participants in the control group). This demonstrates that despite being delivered in a less
controlled public environment, the intervention can still lead to positive improvements in young
children’s handwashing practices. This findings agree with this study, where majority of the
respondents (90%) indicated that hand washing was done through demonstrations and reminders
were done through the use of songs.
When asked if the school had a hand washing routine in the school, minority (40%) of the
respondents indicated that the school had a hand washing routine which was carried out before
eating lunch, which was supervised by the teacher on duty, in addition, usage of soap among the
students was observed during lunch time unlike during tea break and toilet break, this findings
agreed to Greene LE et.al in Western Kenya where observed hand washing of school children
increased in interventional schools, the knowledge of using soap for hand washing before meal
and after toilet use increased significantly. This implies significant increase in knowledge among
the students that they should wash their hands before lunch.
Null Hypothesis: The mean level of compliance to hand hygiene among children in early
childhood centres within Chemundu location is high.
Alternative Hypothesis: The mean level of compliance to hand hygiene among children
in early childhood centres within Chemundu location is low.
The hypothesized mean value for the level of compliance was 1.5. Mean values that are
greater than 1.5 indicate a low level of compliance while the mean values lower than the
hypothesized mean value indicate high compliance. From table 8, the mean level of
compliance during the lunch break was 1.7360, during tea break was 1.7361 and at the toilet
was 1.7314. The corresponding t values at 45 degrees of freedom were: 27.568, 27.567 and
28.699. For all three areas, the p-value was 0.00. Since the p-value is less than 0.05 level of
significance, we reject the null hypothesis and conclude that the level of compliance to hand
hygiene among children in early childhood centres within Chemundu location is low.
4.4. FINDINGS UNDER ENVIRONMENTAL CONDITIOND FOR HAND
WASHING COMPLIANCE.
Figure 14: showing availability of Handwashing station

Object 30
The above bar graph shows that all both the schools had hand washing stations which had
adequate water and soap as it is required. This shows that hand washing is being practiced in this
schools and measures are being put in place in order to promote hand washing.
Table 16: showing reachability of hand washing stations.
frequency percent
Reachability of the hand
washing station
Reachable 2 100
Within the latrine
No 2 100
Outside the latrine

Yes 2 100
Close to the classroom
Yes 2 100
Far from classroom
No 2 100
Next to cafeteria
Yes
No 1 50
1 50
Far from cafeteria
No 1 50
Yes 1 50
Presence of water supply
Yes 100
Availability of soap
Available 100
Material for wiping hands
Absent 100
2
The hand washing system
Jerry cans 50
Piped water 50
Taps 100
Sinks
Absent 100
Condition of the hand
washing facility 100
Bad condition 2
Variety of the facility 100
Uniform size 2
The above table shows that the hand washing station were reachable in both the institutions
(100%).Within the latrine there were no hand washing station (100%).The hand washing stations
were outside the latrine (100%). Hand washing stations were also close to the class room (100%)
and not far from the classrooms. One institution had a hand washing facility next to the cafeteria
(50%) while the other one was far from the cafeteria (50%). The institutions both had water
supply (100%). Soap was available in both institutions (100%). Both institutions lacked wiping
materials (100%) which means that none of the children dried their hands. Hand washing stations
used in these institutions included jerry cans (50%), piped water (50%), and taps were available
(100%) while sinks were absent (100%). Conditions of these hand washing stations were all in
bad condition (100%) but the variety of the facility were all in uniform sizes (100%).
Table 17: showing the frequency and percent of Hand sanitizer utilization in the school
Frequency Percent
Availability of the sanitizers
available 2
100
Placement of the hand
sanitizers
Administration office 2 100
Usage of sanitizers
Teachers 1 50
Administration 1 50
On availability of hand sanitizers, the findings indicated that hand sanitizers were available
(100%) and that the hand sanitizer was being placed in the administration office (100%) used by
the teachers (50%) and the administration itself (50%).
Table 18: showing the frequency and percent of Water supply in the school and the
adequacy of the water.
Frequency Percent
Piped water 1 50
Rain water 1 50
Adequacy of water supply
Adequate 1 50
Inadequate 1 50
On the table above one institution was found to use piped water (50%) while the other one was
found to use rain water (50%) which means that the school harvests rain water. The adequacy of
the water in one institution was adequate (50%) while in the other it was inadequate (50%).
Table 19: showing the frequency and percent of the number of hand washing facilities and
the number of students using the facilities
Frequency Percent
Number of hand washing
facility
4_6 1 50
7_9 1 50
Number of children using
hand washing facility
All 2 100
Number of sinks
None 2 100
Number of children using
the sinks 100
None
Number of taps 100
1_3
Number of children using 2
taps 100
All
The above table shows that the number of hand washing facilities were between 4_6 (50%) and
7_9(50%) where one facility had 5 hand washing facilities and the other one had 7 had washing
facilities. All children (100%) used the hand washing facilities. Sinks were not available (100%)
which means that none of the children used sinks (100%). Number of taps were between 1_3
(100%) and all the children used the taps.

Table 20: showing the nature of water supply.
Nature of the water supply

Adequate water 6 60.0
supply
Inadequate water 2 20.0
Valid
supply
Reliable and regular 2 20.0
Total 10 100.0
The institutions reported adequate water supply (60%), inadequate water supply (20%) and
reliable and regular water supply (20%). This implies that the school has adequate supply of
water and therefore hand washing should be a key part of the day to day activity.
Figure 15: showing the quality of water

Object 32
91% of the water that is being used in hand washing is clean and 9% is unsafe, therefore the
water is adequate, clean and safe for use among the children, the teachers and the staff in general.
Table 21: One sample T-test on Environmental determinants in relation to Compliance Level
Std. Std. Error

Environmental 2 1.9200 .22627 .16000
Determinants
One-Sample Test
Test Value = 1.5
Sig. (2- Mean
the Difference
t do tailed) Difference Lower Upper
Environmental 2.625 1 .232 .42000 -1.6130 2.4530
Determinants
4.4.1. DISCUSSION OF FINDINGS UNDER ENVIRONMENTAL
CONDITIONS FOR HAND WASHING COMPLIANCE.
This study aimed at investigating the different environmental factors that influenced hand
washing in the schools, the study found out that none of the schools observed had a paper towel
for drying of hands, the findings from the observational checklist also indicate that the schools
had a hand washing station outside the latrine, close to the classroom and next to the cafeteria.
However, the hand washing stations outside the latrine and close to the classroom in the public
schools lacked water unlike those in private school. In a study carried out in Bogota, Colombia,
it found out that availability and accessibility to water and soap were more commonly reported
by students from private schools (10.8%) than by those from public schools (4.7%). This is
similar to our observations where only one station had soap for hand washing, and this was in the
public school, meanwhile, all the stations in the private school had soaps for hand washing.
In addition, the form of hand washing being used in the schools was both the use of jerry can
taps and piped water, no school had sinks for hand washing, and they all depended on taps and
jerry cans for hand washing. Bogota (2011) reported that all schools must have a minimum of 1
operating sink and toilet or urinal for every 25 children. When asked the nature of the water
supply being used in hand washing in the school, 60% of the respondents indicated that the water
was adequate where 20% of the respondents indicated that water was inadequate, only 20% of
the respondents stated that the water was reliable and regular. Therefore, since hands are the
primary vehicle of transmission of many infectious diseases, providing accessible water and soap
in toilet area can be effective for potentially reducing this problem by properly practicing hand
washing in the school children. Hand washing with soap is one of the most important hygiene
behaviours which should be promoted among school children since it beaks dirt and grease that
carries most of the germs which cannot be removed by water alone.
Null Hypothesis: The mean level of compliance of children’s hand hygiene in early
childhood centres is low due to environmental factors within Chemundu location.
Alternative Hypothesis: The mean level of compliance of children’s hand hygiene in
early childhood centres is high due to environmental factors within Chemundu location.
The hypothesized mean value for the level of compliance with environmental factors was
1.5. Mean values that are greater than 1.5 indicate a low level of compliance while the mean
values lower than the hypothesized mean value indicate high compliance. From table 8, the t
value at 1 degree of freedom was 2.635. The p-value was 0.232. The p-value is greater than 0.05
hence we fail to reject the null hypothesis and conclude that the mean level of compliance of
children’s hand hygiene in early childhood centres is low due to environmental factors within
Chemundu location.
4.5. FINDINGS UNDER SCHOOL ADMINISTRATIVE FACTORS AND
COMPLIANCE.
SCHOOL SUPERVISION PROGRAM.

Figure 16: showing who gives assistance to the children.
ASSISTANCE.
1; 9.09%
1
2
2; 90.91%
Class teachers are mainly the ones that are in charge of supervising the students during hand
washing process, at 70%, and the teacher on duty at 30%. This is because the class teachers are
in charge of the class therefore they have to take the responsibility of supervision.
Table 22: showing the frequencies and percent of compliance and supervision to hand
washing.
Frequency Percent
During toilet break
1 minute to 5 minute 2 100
During tea break
During lunch break
Supervision during toilet
break
None 2 100
Supervision during lunch
time
Class teacher 2 100
Supervision during tea break
Class teacher 2 100

Table above shows that during toilet break, tea break and lunch break, the children took 1 minute
_5 minutes (100%). It also shows that there was no supervision of hand washing during toilet
break (100%), the class teacher was responsible of hand washing during lunch time (50%) and
tea break (50%).
Table 23: showing who enforces hand washing in the school.
Enforcement Frequency Percent
Head teacher 1 10.0
Class teacher 3 30.0
Teacher on duty 6 60.0
Table 2 under who enforces hand washing in the school, the findings indicated that the Teacher
on duty is the one responsible for enforcing hand washing, at 60%, the Class Teacher 30% and
the Head Teacher at 10%. The teachers are given duties to oversee the activities in the school
during the week, and therefore the teacher on duty is in charge of ensuring the students wash
their hands.
Health information provision by the school and Health Education.
Table 24: showing the frequencies and percent on availability of books in the different
classes and topics covered.
Frequency percent
Pp1
Present 1 50
Absent 1 50
Pp2
Present 1 50
Absent 1 50
Grade 1
Present 1 50
Absent 1 50
Topics covered books
When to wash hands
Yes 1 50
No 1 50
How to wash hands
Yes 1 50
No 1 50
Places to wash hands
Yes 1 50
No 1 50
What to use when washing
hands
Yes 1 50
No 1 50
Drying of hands
Yes 1 50
No 1 50
On table above, books on hand washing were both present (50%) and absent (50%) in PP1, PP2
and Grade 1. The topics on when to wash hands, how to wash hands , places to wash hands ,
what to used when washing hands and drying hands were partly covered (50%) and partly not
covered (50%).
Table 25: showing the frequency and percent of Posters on hand washing.
Frequency Percent
Availability of posters
Present 1 50
Absent 1 50
Nature of the posters
Easy to read 1 50
Not applicable 1 50
Types of messages
Relating to hand washing 1 50
not applicable 1 50
Findings show that Posters were present (50%) and also absent (50%) and the nature of these
posters were easy to read (50%) for the institution that lacked posters this wasn’t applicable
(50%). These posters had messages that related to hand washing (50%).In scenario where posters
weren’t available this wasn’t applicable (50%).
Table 26: showing if the school provides health education on hand washing
Health education Frequency Percent
Yes 10 100.0
Table 26 under thematic section health education, all the respondents stated that health education
is carried in the school. The different aspects of hand washing such as why wash hands, when to
wash hands and steps of hand washing are therefore taught to the children.
Table 27: showing when the health education is provided in the school
Health education Frequency Percent
School assembly 1 10.0

In class taught by the teacher 9 90.0
Table 27 shows that health education is mainly carried out by the class teacher during class
lessons (90%) and only 10% during the school assembly. The teaching process is done through
demonstrations and therefore the class teacher will have an easier time to indicate the hand
washing process and to teach about it during class sessions.

Table 28: showing how often the health education is given.
Frequency of health education Frequency Percent
Weekly 6 60.0
Twice a week 3 30.0
When necessary 1 10.0
Table 28 shows that health education is mainly taught weekly in the school (60%), 30% indicated
that the health education is done twice a week, whereas 10% indicated that health education is
done only when it’s necessary. The coverage of hand washing is therefore broad since the
children are taught on hand washing on a weekly basis.
Table 29: showing if the school invites guests to talk on hand washing
Guests Frequency Percent
Yes 5 50.0
No 5 50.0
Table 29 indicates that the respondents had a different view on the guests invited to talk on hand
washing, 50% reported guests were invited whereas 50% reported that no guests are invited to
talk about hand washing.
Table 30: showing the visitors who have visited the school to carry out health education
Visitors Frequency Percent

Public health officer 5 50.0
Ueab students 4 40.0
None 1 10.0
The respondents indicated that 50% of the visitors who were invited to talk on hand washing are
Public Health Officer (50%), Baraton students (40%), and 10% indicated no visitors comes to
talk on hand washing. Public Health Officers are well suited since they know the importance of
hand washing when it comes to reducing the risk associated with poor hygiene.
Table 31: showing if awarding of students who adhere to handwashing is done
Awards Frequency Percent
Yes 3 30.0
No 7 70.0
70% of the respondents indicated students who adhere to hand washing are awarded, where as
30% indicated that students are not awarded. The awards given to students range from
stationeries, badges or school uniforms. This builds a positive attitude towards hand washing in
the school.
Table 32: showing the posters that have steps on hand washing
Steps Frequency Percent

Yes 3 30.0
No 7 70.0
70% of the respondents indicated that there are no posters on hand washing in the school,
whereas 30% indicated there are posters on handwashing in the school. This is due to the fact
that the teaching process is done through demonstrations to the students.
Table 33: showing frequencies and valid percent of posters that have the importance on
hand washing
Importance of hand washing posters Frequency Percent
Yes 4 40.0
No 6 60.0
Table 33 indicates there are no posters in the schools that indicate the importance of hand
washing, 60% of the respondents stated there are no such posters whereas 40% indicated that the
posters on importance of hand washing are present in the school.
Table 34: showing the frequencies and valid percentage on posters that indicate when to
wash hands
When to wash hands posters Frequency Percent
Yes 2 20.0
No 8 80.0
Table 34 indicates that the schools do not have posters that indicate on when to wash hands, 80%
of the respondents stated there are no posters, whereas 20% indicated there are posters on when
to wash hands. This is due to the fact that the process is mainly due to demonstrations used to
teach on hand washing.
Table 35: showing the posters that indicate why they should wash hands.
Why they should wash hands Frequency Percent
Yes 1 10.0
No 9 90.0
90% of the respondents indicated that there are no posters in the school that indicate on why the
students should wash their hands, whereas 10% indicated there are posters that indicate there are
posters that show why students should wash their hands.
Table 36: showing frequencies and percentage of posters with flipcharts.
Flipcharts posters Frequency Percent
Yes 1 10.0
No 9 90.0
90% of the respondents indicated that there are no posters with flipcharts that guide on
handwashing in the school, whereas 10% indicated there are posters with flipcharts. Hand
washing activity is mainly done through demonstrations in the lower classes, therefore the school
has not invested heavily in posters guiding on hand washing.

Table 37: showing availability of posters
Availability of posters Frequency Percent

AVAILABLE 10 100.0
The table indicates that the schools have posters, that majority of the posters are not related to
handwashing, the posters available in the school were mainly posters on Coved 19, which
although covered hand washing it was in relation to prevent the spread of the disease.
Figure 17: showing the time children are taught about hand washing
Object 36
Hand washing is mainly taught during the class lessons (80%), and during parade time (20%).
The teachers in the different institutions mainly teach their students the different aspects on hand
washing during the class lessons, using the different demonstrations.

Figure 18: showing the frequency of soap
Frequencyofsoap
9.09%
1
2
90.91%
The respondents reported that 90% of the time the children went for hand washing the soap was
always available, where as 10% of the time there was no soap to be used by the children to wash
hands. Both water and soap were readily available for hand washing.
Figure 19: showing soap replacement.
Soap replacem ent.
60 50.0
50
40 30.0
30
20 10.0 10.0
10 5 1 3 1
0
l y y y p
te da da s oa
ia a ra f
ed in e yo
m ith Af li t
Im W bi
a i la
av
e
th
sn
e nd
p
de
It
Majority of the respondents indicated that soaps in the hand washing facilities are usually
replaced immediately (50%), where as 30% of the respondents stated that soaps are replaced
after a day, only 10% indicated replacement of soap within a day and others it depended on the
availability of soap. This implies that the school has come up with measures to ensure that soaps
are replaced immediately they are over at each station.

Table 38: showing the time the school expects children to wash hands.
Frequency Percent
Valid After visiting the toilet 7 70.0
Before eating 3 30.0
Total 10 100.0
Majority of the respondents (70%) indicated that they expect the children to wash their hands
after visiting the toilet, where as 30% stated that they expected the children to wash hands before
eating. This implies the school focuses to strict hand washing among kids before they take their
meals and after they visit the toilet.
Figure 20: showing the level of learning.

Object 42
Hand washing in the facility is mainly taught to the students in the PP1 class (60%), this is where
the demonstrations are done and as the kids move to the next class they are taught the different
aspects of hand washing. Only 30% of indicated that hand washing is taught in grade 1.
Promotion of hygiene through clubs, curriculum, educational activities and incentives.

Figure 21: showing the subjects that hand washing is taught.
Object 44
70% of the respondents stated that hand washing in the school is taught during environmental
study lessons, whereas 20% of the respondents stated it’s done during English lessons and lastly
only 10% said it’s taught during the hygiene and nutrition classes. This implies that due to the
change in the curriculum, the different aspects of hand washing are under environmental studies,
and different environmental determinants are also taught such as usage of taps, sinks and soaps.
Table 39: showing the hygiene and sanitation club.
frequency valid percent

Hygiene and sanitation club
Yes 1 10.0
No 9 90.0
The table indicates that the school does not have a hygiene and sanitation club (90%), this is
from the lower primary to upper primary, and this implies that sensitization to hand washing is
done in classes by the teachers only.
Figure 22: showing hand washing celebration day.

Object 46
Majority of the respondents (60%) indicated that the school participates in hand washing day,
which is celebrated on 15th October every year. The school focuses on teaching the students the
importance of hand washing, as it helps reduce the diarrheal diseases and respiratory infections.
They also teach on the steps of hand washing, this is done in classes through demonstrations.
Figure 23: showing if the school has Hand Washing day
Object 48
80% of the respondents stated that they do not have a specific day in school set aside for hand
washing activities, the activity is done daily before meals and after children visit the washrooms.
This implies that the school does not have a specific hand washing day and they only celebrate
with the rest of the world on 15th October.
Figure 24: showing Hand Washing Policies in the school.
Object 50
60% of the respondents stated that the school hand washing policies which they adhered to, some
of the policies include washing hands before taking meals, where the teacher on duty supervises
the activity. Visitors are supposed to sanitize their hands when they come into the school, use of
soaps to wash hands after visiting the toilets, this implies that the schools have set up measures to
ensure hand washing in the school is enforced and carried out well.
Table 40: showing if the school has a budget for Hand washing
Budget Frequency Percent
Yes 9 90.0
No 1 10.0
Majority of the respondents indicated that the school had set up some resources to ensure
optimum hand washing in the school is achieved, for most schools, the budget was less that 5000
(see table) where they budgeted for soaps and sanitizers to be used within the school.
Table 41: showing the budget amount for the school
Mean Median Mode Std. Variance Range Minimu Maximu
deviation m m
School 3950.000 4000.000 5000.0 3789.2391 14358333.33 10000.0 0.00 10000.00
budget 0 0 0 5 3 0
amoun
t
The table above shows that most of the respondents have a budget of averagely 3950ksh and the
middle budget is 4000 ksh. The most appearing budget is 5000. The minimum budget is 0ksh
while the maximum budget is 10,000ksh.
Table 42: One sample T-test on administrative factors in relation to Compliance Level
Std. Std. Error

School Administrative 10 129.2419 122.19121 38.64025
Factors
One-Sample Test
Test Value = 100
95% Confidence Interval
Sig. (2- Mean
of the Difference
School Administrative .757 9 .469 29.24194 -58.1684 116.6523
Factors
4.5.1. DISCUSSION OF FINDINGS UNDER SCHOOL
ADMINISTRATIVE FACTOR AND COMPLIANCE.
70% of the respondents indicated that the class teacher was the one assisting students to wash
their hands after visiting the toilet, whereas 60% of the respondents indicated that the teacher on
duty enforces hand washing on weekly basis. This implies that students both the teacher on duty
and class teacher are responsible for the sensitization and supervision of the hand washing
activity in the school. A research (Pittet 2001) found out that one of the reasons for poor
adherence with hand hygiene, included lack of institutional priority for hand hygiene, need for
administrative sanctions for noncompliance or rewards for compliance. However, this was not
the case in many of the schools, 70% of the respondents indicated that the schools did not award
the students who adhered to hand washing.
Health information provision by the school and Health Education.
Availability of books on hand washing from the study was found to be 50% in all classes
that is PP1, PP2, and Grade 1. Topics on hand washing on the other hand were not covered fully
50%. This clearly shows that information on hand washing is not adequately given to the
children hence the reason behind having a few number of children managing to follow some of
the steps of hand washing. Posters were not sufficiently present in the schools although for those
that were present 50 % some were easy to ready 50% and the message related to hand washing.
The respondents indicated that health education is carried out in the school, 90% of the
respondents indicated that the health education in the school is done during the class lessons,
where the teachers engage with the students. In addition, 60% indicated that the activity is
carried out on weekly basis, and guests are invited into the school to give health talks on hand
washing, 50% of the speakers were Public Health Officers and 40% were UEAB students.
Promotion of hygiene clubs, curriculum, educational and incentives
Nevertheless, 90% of the respondents indicated that the school did not have hygiene and
sanitation club, hand washing was discussed mainly in Environment Studies as indicated by 70%
of the respondents, 20% said it was done during English lessons and 10% during hygiene and
nutrition lessons. A study done by (Chittleborough, 2012) shows that health education is
successful in increasing knowledge and awareness about the spread of infection and hand
hygiene through provision of education and information and visual and verbal reminders.
Therefore the schools should provide opportunities for hand washing in terms of time and
facilities, and also promote the importance of hand washing through information, setting good
examples to the pupils as the school, having hand washing in daily routines may also improve
hand washing practices ir-respective of the presence of a specific educational intervention.
The research investigated the amount of budgeted that was allocated for hand washing,
30% of the respondents stated that the budget amount was around 5000, the least (10%) indicated
their budget amount was below 500 shillings. This implies that the schools have set up measures
to ensure hand washing is carried out in the school, majority of the respondents indicated they
budgeted for soaps, sanitizers and containers for hand washing.
Null Hypothesis: The mean level of compliance of children’s hand hygiene in early
childhood centres is low due to school administrative factors within Chemundu location.
Alternative hypothesis: The mean level of compliance of children’s hand hygiene in early
childhood centres is high due to school administrative factors within Chemundu location.
The hypothesized mean value for the level of compliance with environmental factors was
100. Mean values that are greater than 100 indicate a low level of compliance while the mean
values lower than the hypothesized mean value (100) indicate high compliance. From table 8, the
t value at 9 degrees of freedom was 0.757. The p-value was 0.469. The p-value is greater than
0.05 hence we fail to reject the null hypothesis and conclude that the mean level of compliance
of children’s hand hygiene in early childhood centres is low due to school administrative factors
within Chemundu location.

Table 43: Summary
Variable Test Mean Degrees t value P-value
value of
Freedom
(Do)
Level of 1.5 1.7360 45 27.568 0.000
Compliance
(Lunch break)
Level of 1.5 1.7361 45 27.567 0.000
Compliance (Tea
break)
Level of 1.5 1.7314 45 28.699 0.000
Compliance
(Toilet)
Environmental 1.5 1.9200 1 2.625 0.232
determinants
School 100 129.2419 9 0.757 0.469
Administrative
Factors
CHAPTER 5: CONCLUSION AND RECOMMENDATION
5.1. CONCLUSION
The aim of the study was to assess the determinants of compliance of children’s hand hygiene in
early childhood centres within Chemundu Location, from our findings, the following conclusions
were made:
1. The level of compliance among the children in lower primary is low, that is why they
did not follow the steps of hand washing. Majority of them failed to wash their hands
during toilet break and tea break, they only adhered to hand washing when
supervised, and therefore the level of knowledge on hand washing practices among
the children could be insufficient.
2. The findings show that majority of the school’s hand washing station were reachable
to the students, however, many of the washing stations lacked water, soaps and drying
materials to dry their hands. This factors aggravate why children did not adhere to
hand washing. Nevertheless, hand sanitizers were only available in the administration
offices.
3. It is also observed that the budgeting of the schools towards hand washing was low
(less than 5000), which not enough to cater for the items necessary for hand was
washing. Enforcement of the different school policies was done by the head teacher
and teacher on duty. Posters, flip charts and books to promote hand washing were not
adequate in the schools. In addition to that, the method used to teach hand washing
was demonstrations this could have led to the having few number of children who
adhered to hand washing.
5.2. RECOMMENDATION.
1. Public health officials can help improve the adherence to hand washing in the schools by
carrying out routine inspections in the schools, and encouraging the schools to adopt
measure such as posters and books that will educate on hand washing. They can also
carry out health education to the children, their routine inspections will make the schools
put up the sinks and taps that will encourage hand washing in the schools.
2. The Ministry of Health and County governments should address hand washing, this will
be done to create awareness on the importance of hand washing, and will also help reduce
diarrheal diseases among these children. The Ministry should also distribute books to the
schools, that touch on and washing.
3. The principals of the different schools should encourage the formation of sanitation and
hygiene clubs in the schools, enforcement of the different policies in their schools, and
encouraging the teachers to adopt different measures to teach on hand washing other than
demonstrations and use of songs.
4. To the Public Health Department of UEAB, the department can encourage their students
to actively participate in health promotion campaigns in the schools. Students can
volunteer and engage with the students in health promotion.

BUDGET
Table 44: Showing the budget for the research study
ITEMS NUMBER OF UNIT COST(KSH) TOTAL COST IN

ITEM
(KSH)
Pens 5 @15ksh Ksh. 75/=
Pencils 5 @ 10ksh Ksh. 50/=
Printing 200 pages @5ksh Ksh. 1000/=
Printing paper 2 reams @450ksh Ksh. 900/=

Photocopying 500pages @3ksh Ksh. 1500/=
Binding 7 copies @100ksh Ksh. 700/=

Transport to different 6 trips @150ksh Ksh. 900/=
schools.
Ethical review fee @200ksh Ksh. 200/=
SUB-TOTAL Ksh. 5325/=
10% CONTINGENCY cost of Sub-total Ksh. 532.50/=
TOTAL AMOUNT Ksh. 5857.50
WORKPLAN
Table 4: Gantt chart showing the work plan for my Research study.
DEC MAR APR
JAN FEB MAR APR MAY AU SEP 0CT NOV (2020) 2021 2021
2020 2020 2020 IL 2020 G 2020 2020 2020 _
2020 2020 FEB
(2021)
Identification of
research problem
Developing
research
objectives
Literature Review
Methodology
Design Data
collection tools
Pilot Study
Main study data
collection
Defending
Data Entry and
Cleaning
Data Analysis
Report Writing
Presentation
Data
Dissemination
APPENDICES
APPENDIX 1: INFORMATION AND CONSENT FORM
Dear Parent/ Guardian,
I am THELMA MWENI a senior student in the University of Eastern Africa Baraton,

Department of Public Health. I am conducting a research entitled; “DETERMINANTS OF
COMPLIANCE IN EARLY CHILDHOOD CENTRES WITHIN CHEMUNDU
LOCATION.”
I am hereby requesting for your authorization in allowing your child to participate in the
research study. The aim of the study is to assess the determinants of compliance of children’s
hand hygiene in early childhood centres within Chemundu Location. The study will be carried
out among PP1, PP2 and grade 1. The pilot study will be done at Father Boyle Academy.
The researcher understands that all the children to be studied who are in the above classes
are minors and therefore it requires that their parents are given informed consent on their behalf
and also sign on behalf of the child if the child accepts to take part in the study.
The researcher shall observe the pupils behaviours towards hand washing and also issue
questionnaires to the class teachers and the school administration.
You are free to voluntarily accept your child to participate in the study or refuse to allow
your child’s participation. Besides, you are allowed to request for withdrawal of your child at any
time during the study. There is no penalization or victimization whatsoever upon refusal or
withdrawal of your child from the study as a parent or upon the child’s request to not participate.
2. CONSENT FORM
I have read and understood about the research, what will be done during the research and
how my child will be involved in the research study. I therefore give my consent / permission to
allow my child participate in this research study. I understand that participation is voluntary and
my child can withdraw from the study or I can withdraw my child from the study at any time
without any victimization or penalization.
Parental / Guardian Consent

I hereby consent and accept my child to participate in this study voluntarily.
Signature of parent: Date
Child’s Assent
I have explained to my child about the study and the measurements and questions to be asked
about the research. My child has understood and is willing to participate in the study. (The Child
can only sign under parental authorization).
Signature of parent /Child: Date
Investigator
I have sent the form to the parent and received the form signed after the parent and child
understood the study and signed it giving their informed consent and assent respectively.
Investigator’s signature _______________________ Date_________________
Investigator: Course Coordinator:
Ms Thelma Mweni Ms Asenath Nyantika-Barongo
Department of Public Health, Department of Public Health
University of Eastern Africa Baraton, University of Eastern Africa, Baraton,
P.O. BOX 2500, P.O. BOX 2500
ELDORET. ELDORET.
Email: mwenit010@gmail.com Email: barongoas@ueab.ac.ke
Phone Number: 0778061811 Phone: 0721 884318
APPENDIX 2: RESEARCH QUESTIONNAIRE
RESEARCH QUESTIONNAIRE.
QUESTIONNAIRE.
QUESTIONNAIRE ASSESSING THE TEACHERS ON DETERMINANTS OF
COMPLIANCE TO HAND HYGIENE IN EARLY CHILDHOOD CENTRES IN
CHEMUNDU LOCATION.
Dear teacher,
I am a senior student, in the department of Public Health, at the University of Eastern Africa
Baraton. I am carrying out a study on the “determinants of compliance to hand hygiene in
early childhood centres which will be carried out in Chemundu location.” The information
that you will provide in this questionnaire will be confidential and will be used purely for
academic purposes, I therefore kindly request you to freely respond to all questions in this
questionnaire. Your participation in this study is voluntary and will be highly appreciated.
Withdrawal is at your own will too.
QUESTIONNAIRE NO. ______________ DATE._______________
Below are the questions that you are kindly requested to answer as honest as possible. Kindly
tick √ in the space provided to next to the responses to indicate your response which applies to
you to each of the questions OR write in the dotted lines the appropriate response.
A. DEMOGRAPHIC INFORMATION.
1. What is your age?
20- 25 years 26-30 years 31-35 years
36 -40 years 40 – 45 years 46 – 50 years
51 - 55 years above 56 years
2. What is your Gender?
Male Female
3. How long have you worked in this school _____________________________years.
4. Which class are you in charge of? _______________________________
B. SCHOOL ADMINISTRATIVE FACTORS
5. Which of the following aspects on hand washing are the children in your class award of?
When to wash hands ()
Steps in washing hands ()
Why wash hands ()
6. How are they taught about hand washing?
Demonstrations ()
Posters ()
Pictures ()
Singing of hand washing songs ()
Never taught them hand washing ()
7. When are they taught about hand washing?
During class lessons ()
During parade time ()
During break time ()
8. Who assist the pupils in your class with handwashing after visiting the toilet?
None ()
Me (class teacher) ()
Special staff ()
Teacher on duty ()
Class prefect ()
Other________________________
C. ENVIRONMENTAL DETERMINANTS.
9. What is the nature of the water supply
Adequate water supply ()
Inadequate water supply ()
Reliable and regular ()
Unreliable and irregular ()
10. What is the quality of the water being used to wash hands?
Clean () dirty ()
Safe () Unsafe (0
11. Is the soap frequently available?
Yes () No ()
12. How long does it take to replace the soap?
Immediately ()
Within a day ()
After a day ()
It depends on availability of soap in the office ()
After a week ()
After a month ()
After a term ()
13. What times does the school have for hand washing as a routine
None. () Immediately after break ()
Before assembly () Before eating lunch ()
Before going home () After games ()
14. What times does the school expect children to wash their hands?
After visiting the toilet () Before eating ()
After eating () After playing ()
After break time ()
15. Which level of learning is handwashing taught within the school curriculum?
Baby class () Grade 1 () PP1 () PP2 ()
16. Under which subjects is hand washing taught within the current school curriculum?
English / Language () Kiswahili ()
Mathematics () Environment studies ()
Others ________________________________________
17. Does the school have a hygiene and sanitation club in the school?
Yes ()
No ()
18. Does the school celebrate Handwashing Day?
Yes ()
No ()
19. Does the school have a hand washing day?
Yes ()
No ()
20. Does the school have handwashing policies?
Yes ()
No ()
a. If yes, state them.
21. Does the school have a budget on hand washing?
Yes () No ()
22. How much is the budget for hand washing ___________________________
23. What items are budgeted for in the hand washing budget?
______________________________________________________________________________
______________________________________________________________________________
___________________________________________________________
24. Who ensures that hand washing is enforced in the school?
School head teacher () School deputy teacher ()
Class teacher () Teacher on duty ()
25. Does the school provide health education on hand washing?
Yes ()
No ()
26. When is health education on hand washing provided?
School assembly () Class meetings ()
In class taught by the teacher ()
27. What topics do you cover on hand washing when teaching the children?
28. What methods do you use to remind children about hand washing?
29. How often is health education on hand hygiene given in this school?
Weekly () Twice a week () Monthly ()
Once per term () When necessary ()
30. Does the school invite speakers or guests to talk on hand hygiene?
Yes ()
No ()
31. Who of the following persons has ever visited the school and given education on hand washing
as guests?
Nurse ()
Public health officer ()
UEAB students ()
None ()
Others_____________________________________
32. Does the school award children who adhere to hand washing?
Yes ()
No ()
33. What kind awards has the school given to those who adhere to hand washing
_________________________________________________________________________________
___________________________________________________________________________
34. Which of the following posters on hand washing are present in the school
a. Steps in hand washing ()
b. Importance of hand washing ()
c. When to wash hands ()
d. Why wash hands ()
e. Flip charts used for teaching only ()
f. No posters available ()
D. LEVEL OF COMPLIANCE TO HAND WASHING
35. What percentage of your pupils always remember to wash their hands after doing the
following activities
a. Visiting the toilet ________________________
b. Before taking tea ________________________
c. Before taking lunch __________________________
d. To use soap ________________________
e. Follow all the steps in hand washing ___________________________
APPENDIX 3: OBSERVATIONAL CHECKLIST.

GENERAL OBSERVATIONAL CHECKLIST.
OBSERVATIONAL CHECKLIST
RESEARCH ON COMPLIANCE TO HAND WASHING AMONG CHILDREN
IN EARLY CHILDHOOD CENTERS IN CHEMUNDU LOCATION
Name of School_________________________________________________________
Date and time of Assessment_______________________________________________
A. ASSESSMENT OF ENVIRONMENTAL DETERMINANTS

1. The status of the various environmental components for hand washing in schools?
ENVIRONMENTAL Tick the according to Comments
DETERMINANTS. what applies
Hand washing station Present.

Absent.
Hand washing station Within the
latrine.
Outside the
latrine.
Close to
classroom.
Far from
classroom.
Next to
cafeteria/eatin
g area
Far from
cafeteria/eatin
g area
Presence of water Yes
supply around the
No
washing station.
Availability of soap for Available
handwashing.
Not available
Material for wiping Use of a

hands available. towel.
Use of tissue
paper.
Air drying.
Wiping on
clothes.
None
Hand sanitizers. Available

Not Available
School hand washing Reachable
facilities?
Not reachable
N/A
Water supply in the Piped water.

school.
Rain water.
Well water.
The form of hand Jerry can taps
washing system.
Tippy tap
Piped water
Sinks Used
Not Used
Taps Used
Not used
Type of soap Liquid
Solid.
Posters on hand Present
washing. Not present
Pinned on the
walls in class
rooms
Pinned next to
the washing
areas.
Nature of posters. easy to read
not easy to
read
Type of message on Relating to
posters. hand washing.
Not related to
hand washing.
Water supply. Adequate
Not adequate
Nature of water Permit hands
storage container. to touch
Permit hands
not to touch
Possibility of
contamination.
Placement of hand Administratio
sanitizer. n office.
Staff room.
Classroom.
Kitchen.
On hand
washing
stations.
Hand washing facility. Good
condition.
Bad condition.
Washing facilities of Variety
different variety? according to
height of kids
Uniform size
Fits only
upper primary
children
Fits only ECD

kids
Fits only
lower primary
children
Hand washing Baby class
facilities reachable to kids
PP1
PP2
Grade 1
Grade 2
Who uses the hand The school
sanitizers available in administration.
the school?
Teachers.
Pupils.
Other staff
members.
2. Indicate the number of facilities against the number of children

Number Number Used by who ( tick Comments
of of accordingly)
FACILITIES
facilities children
using
them
Baby PP1 PP2 Grade 1
class
Hand washing
facility.
Sinks.
Taps.
B. COMPLIANCE TO HAND WASHING

Indicate the duration taken to queue during the different times.
Hand washing time. Duration taken to queue.
Toilet break.
Tea break
Lunch break.
C. SCHOOL ADMINISTRATIVE FACTORS
3. Who supervises the hand washing of children at the following times
Toilet break lunch time tea break

a. None
b. Class teacher
c. Teacher on
duty
d. Deputy Head
Teacher.
e. Head teacher.
f. School
prefect.
g. Class prefect
h. School staff.
4. Indicate availability of books on hand washing in the different classes.

Classes Tick according to what applies.
Baby class Present

Absent
PP1 Present
Absent
PP2 Present
Absent
Grade 1 Present
Absent
5. Indicate what is covered on the books on hand washing.

When to How to wash Places to What to use Drying
wash hands. hands. wash hands. when hands.
washing
hands
Covered
Not covered
6. Indicate where applicable.

Tick where it applies.
Availability of a roaster for monitoring hand Present
washing. Absent
Time provided for hand washing for each group
of children.
TOILET BREAK OBSERVATIONAL CHECKLIST
OBSERVATIONAL CHECKLIST ON HANDWASHING COMPLIANCE AMONG ECD
CHILDREN
(TOILET BREAK)
NAME OF SCHOOL___________________________ Date of Assessment________________________
Assessed by: ________________________________________ Signature________________________________________
Indicate the practice on handwashing for various children during toilet break.
ID. No. of Class of Gender ( Item used to clean hand ( tick Steps done during the hand washing process( tick what Comme
Child child indicate B- what’s observed was observed being done by that particular child) nts
observed for Boy and
No soap
Thumb rubbing
Just Wiped hand
Washing wrists
Rinsing hands
Drying hands
Used hand sanitizer

Use soap
Forget to use soap

G for Girl)
CHILDREN
(LUNCH BREAK)
Indicate the practice on handwashing for various children during lunch break.
No soap
Thumb rubbing
Just Wiped hand
Washing wrists
Rinsing hands
Drying hands
Used hand sanitizer

Use soap
Forget to use soap

G for Girl)
CHILDREN
(TEA BREAK)
Indicate the practice on handwashing for various children during tea break.
No soap
Thumb rubbing
Just Wiped hand
Washing wrists
Rinsing hands
Drying hands
Used hand sanitizer

Use soap
Forget to use soap

G for Girl)
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UNIVERSITY OF EASTERN AFRICA, BARATON

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH.

DETERMINANTS OF COMPLIANCE TO HAND

HYGIENE IN EARLY CHILDHOOD CENTRES

WITHIN CHEMUNDU LOCATION.

A PROPOSAL DONE IN PARTIAL FULLFILLMENT OF THE COURSE

PHHC-496 RESEARCH PROJECT

STUDENT NAME: THELMA MWENI

SUPERVISOR: MR.KHOL HELMUT

COURSE CO-ORDINATOR: MR. OLOUCH EVANCE.

28TH JULY 2021.

undergraduate or postgraduate degree program.

STUDENT’s NAME: THELMA MWENI STUDENT ID: STHEMW1811

STUDENT’S SIGNATURE: …………………… DATE: ………………………

SUPERVISOR’S NAME: MR: KHOL HELMUT

SUPERVISOR’S SIGNATURE: ………………. DATE: ……………………….

COURSE COORDINATOR’S NAME: MS ASENATH NYANTIKA- BARONGO

COURSE CORDINATOR’S SIGNATURE: ……………… DATE: ………………..

me guide, strength and courage all through this research.

words of encouragement and support in writing of this research proposal.

potential pathogens which are harmful microorganisms on the hands.

transition from home to school.

viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to

the hands in order to prevent diseases.

Incidence – it is the occurrence of new cases of disease or injury in a population.

Behavior – it is the way in which a person behaves in response to a particular situation or

WHO – World Health Organization.

ECD – Early Childhood Development.

ECDE – Early Childhood Development Education.

WASH – Water, Sanitation and Hygiene.

IREC- Institutional Research and Ethics Committee.

SPSS- Statistical Package for Social Sciences.

Figure 1: showing the age of respondents.................................................................................................................40

diseases [CITATION Did01 \l 1033 ].

unthinkable.[CITATION Han14 \l 1033 ]. Consequently, health risks to which humans are

hygiene goals [CITATION Did01 \l 1033 ].

hand washing. [CITATION Did01 \l 1033 ].

In order to develop successful interventions to improve hand hygiene compliance and

attending early childhood centres within Chemundu Location.

1.2. Problem statement.

practices often leads to acute gastrointestinal illness in elementary school-aged children.

Consequently, studies have reported the difficulty in translating interventions into

children continues to be a challenging task, especially in developing country contexts, where it is

In addition, compliance with hand hygiene practices by children in a school or day-care

1.3. Justification of the research.

hand hygiene guidelines in hospital care (Erasmus, et al., 2010).

hand hygiene (Busby, et al, 2015).

as study focused on teaching hand washing techniques (Rani, et al., 2021).

health care facilities hand hygiene interventions (Wiednmayer, et al, 2020).

children (Lopez-Quintero, Freeman & Neumark, 2009).

improving student hand hygiene (Pickering, et al, 2013).

among children in early childhood centres within Chemundu location.

1.4. Significance of the study.

hygiene through ensuring a supportive school environment.

1.5. Aim of the study.

within Chemundu Location.

1.6. Specific objectives.

childhood centres within Chemundu location.

2. To determine the environmental determinants associated with compliance of

children’s hand hygiene in early childhood centres within Chemundu location.

3. To determine the school administrative factors associated with compliance of

children’s hand hygiene in early childhood centres within Chemundu Location.