Hand-hygiene beliefs and practices of students in health-related departments of a university in Mogadishu, Somalia
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20261396Keywords:
Beliefs, Mogadishu, Somalia, Hand hygiene, University studentsAbstract
Background: This study aimed to investigate the relationship between hand hygiene beliefs and practices of university students studying in health-related departments in Mogadishu, Somalia. Evidence on hand washing knowledge, attitudes and practices among healthcare students in low- and middle-income countries is limited.
Methods: This study aimed to investigate the relationship between hand hygiene beliefs and practices of university students studying in health-related departments in Mogadishu, Somalia. Evidence on hand washing knowledge, attitudes and practices among healthcare students in low- and middle-income countries is limited.
Results: The mean age of the participants was 20.31±1.85 years and the majority were female (76.6%). The mean Hand Hygiene Beliefs Inventory (HHBI) score was 55.90±11.48, while the mean hand hygiene practices inventory (HHPI) score was 80.16±15.23. A moderate, statistically significant positive correlation was found between HHBI and HHPI scores (r=0.514, p<0.01). Students who reported adherence to hand hygiene practices had significantly higher belief and practice scores compared to those who did not (p<0.01). Regression analysis demonstrated that hand hygiene beliefs were a significant predictor of hand hygiene practices.
Conclusions: Although students demonstrated moderate levels of hand hygiene beliefs and practices, gaps remain that may compromise infection prevention efforts. As hand hygiene belief levels increased, practice levels also improved. These findings highlight the need for targeted educational interventions and multimodal strategies to strengthen hand hygiene beliefs and practices among healthcare-related university students, particularly in resource-limited settings.
References
Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis. 2021;21(8):209–21.
Haque M, McKimm J, Sartelli M, Dhingra S, Labricciosa FM, Islam S, et al. Strategies to prevent healthcare-associated infections: a narrative overview. Risk Manag Healthc Policy. 2020;13:1765–80.
Kraker MEA, Tartari E, Tomczyk S, Twyman A, Francioli LC, Cassini A, et al. Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019. Lancet Infect Dis. 2022;22(6):835–44.
World Health Organization. The burden of health care-associated infection. Geneva: WHO. 2016. Available at: https://www.ncbi.nlm.nih.gov. Accessed on 12 August 2025.
Gaube S, Fischer P, Lermer E. Hand(y) hygiene insights: applying three theoretical models to investigate hospital patients’ and visitors’ hand hygiene behavior. PLoS One. 2021;16(1):245543.
Vermeil T, Peters A, Kilpatrick C, Pires D, Allegranzi B, Pittet D. Hand hygiene in hospitals: anatomy of a revolution. J Hosp Infect. 2019;101(4):383–92.
Al-Anazi S, Al-Dhefeery N, Al-Hjaili R, Al-Duwaihees A, Al-Mutairi A, Al-Saeedi R, et al. Compliance with hand hygiene practices among nursing staff in secondary healthcare hospitals in Kuwait. BMC Health Serv Res. 2022;22:1325.
World Health Organization. WHO calls for better hand hygiene and other infection control practices. 2021. Available at: https://www.who.int/news/itemwho-calls-for-better-hand-hygiene-and-other-infection-control-practices. Accessed on 21 November 2025.
Ataiyero Y, Dyson J, Graham M. Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: a narrative review. Am J Infect Control. 2019;47(5):565–73.
Engdaw GT, Gebrehiwot M, Andualem Z. Hand hygiene compliance and associated factors among health care providers in Central Gondar zone public primary hospitals, Northwest Ethiopia. Antimicrob Resist Infect Control. 2019;8:190.
Ceylan B, Gunes U, Baran L, Ozturk H, Sahbudak G. Examining the hand hygiene beliefs and practices of nursing students and the effectiveness of their handwashing behaviour. J Clin Nurs. 2020;29(2):4057–65.
Labrague LJ, McEnroe-Petitte DM, van de Mortel T, Nasirudeen AMA. A systematic review on hand hygiene knowledge and compliance in student nurses. Int Nurs Rev. 2018;65(3):336–48.
Öncü E, Vayısoğlu SK, Lafcı D, Yıldız E. An evaluation of the effectiveness of nursing students’ hand hygiene compliance: a cross-sectional study. Nurse Educ Today. 2018;65:218–24.
Ahmed Z, Ataullahjan A, Gaffey MF, Osman M, Umutoni C, Bhutta ZA, et al. Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study. Confl Health. 2020;14:35.
Morrison J, Malik SMMR. Population health trends and disease profile in Somalia 1990–2019 and projection to 2030: will the country achieve sustainable development goals 2 and 3. BMC Public Health. 2023;23:66.
Hidig SM. Assessing healthcare challenges in Somalia: a 2024 perspective. Ankara City Hosp Med J. 2024;3(1):47–8.
Sundal JS, Aune AG, Storvig E, Aasland JK, Fjeldsæter KL, Torjuul K. The hand hygiene compliance of student nurses during clinical placements. J Clin Nurs. 2017;26(23):4646–53.
Karadağ M, Yıldırım N, İşeri Ö. El hijyeni inanç ölçeği ve el hijyeni uygulamaları envanterinin geçerlilik ve güvenilirliği. Cukurova Med J. 2016;41:271–84.
Karadag M, Pekin Iseri O, Yildirim N, Etikan I. Knowledge, beliefs and practices of nurses and nursing students for hand hygiene. Jundishapur J Health Sci. 2016;8(4):76.
Kisacik OG, Sonmez M, Cigerci Y. Evaluation of nursing students’ hand hygiene beliefs and practices: a descriptive study. J Higher Educ Sci. 2020;10(3):549.
Okgün Alcan A, Dolgun E. Student nurses’ hand hygiene beliefs and practices. Turk J Fam Med Prim Care. 2019;13(3):279–86.
Van de Mortel T. Development of a questionnaire to assess health care students’ hand hygiene knowledge, beliefs and practices. Aust J Adv Nurs. 2009;26(3):9–16.
van de Mortel TF, Apostolopoulou E, Petrikkos G. A comparison of the hand hygiene knowledge, beliefs and practices of Greek nursing and medical students. Am J Infect Control. 2010;38(1):75–7.
Van De Mortel TF, Kermode S, Progano T, Sansoni J. A comparison of the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students. J Adv Nurs. 2012;68(3):569–79.
Cambil-Martin J, Fernandez-Prada M, Gonzalez-Cabrera J, Rodriguez-Lopez C, Almaraz-Gomez A, Lana-Perez A, et al. Comparison of knowledge, attitudes and hand hygiene behavioral intention in medical and nursing students. J Prev Med Hyg. 2020;61(1):9–14.
Kingston LM, O’Connell NH, Dunne CP. Survey of attitudes and practices of Irish nursing students towards hand hygiene, including handrubbing with alcohol-based hand rub. Nurse Educ Today. 2017;52:57–62.
Tem C, Kong C, Him N, Sann N, Chang SB, Choi J. Hand hygiene of nursing and midwifery students in Cambodia. Int Nurs Rev. 2019;66(4):523–9.
Warsame SA, Ali AM, Mohamed SA, Fetah IO. Factors affecting level of infection control practice in Benadir Hospital, Mogadishu, Somalia. Afr J Health Med Sci. 2017;2(1):11–22.
Kristofina A, Peneyayambeko N. Mastery of the World Health Organization’s techniques of handwashing by nursing students at the University of Namibia. J Nurs Educ Pract. 2016;6(10):74.
Cruz JP, Bashtawi MA. Predictors of hand hygiene practice among Saudi nursing students: a cross-sectional self-reported study. J Infect Public Health. 2016;9(4):485–93.
Purssell E, Gould D. Teaching health care students hand hygiene theory and skills: a systematic review. Int J Environ Health Res. 2022;32(9):2065–73.
Meza Sierra CU, Perez Jaimes GA, Rueda Díaz LJ. Interventions to improve knowledge or compliance to hand hygiene in nursing students: a scoping review. J Infect Prev. 2023;24(1):30–44.
Chassin MR, Mayer C, Nether K. Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance. Jt Comm J Qual Patient Saf. 2015;41(1):4–12.
Singh A, Barnard TG. Health science students’ perceptions of hand hygiene education and practice in a South African university: introducing the university hand hygiene improvement model. Healthcare. 2023;11(18):2553.
Jeong SY, Kim KM. Influencing factors on hand hygiene behavior of nursing students based on theory of planned behavior: a descriptive survey study. Nurse Educ Today. 2016;36:159–64.
Liddelow C, Ferrier A, Mullan B. Understanding the predictors of hand hygiene using aspects of the theory of planned behaviour and temporal self-regulation theory. Psychol Health. 2023;38(5):555–72.
Wai Khuan N, Shaban RZ, van de Mortel T. The influence of religious and cultural beliefs on hand hygiene behaviour in the United Arab Emirates. Infect Dis Health. 2018;23(4):225–36.
Bülbül Maraş G, Kocaçal E. Exploring determinants of hand hygiene among nursing students: a theory of planned behavior approach. BMC Nurs. 2024;23:406.
Yousef RHA, Salem MR, Mahmoud AT. Impact of implementation of a modified World Health Organization multimodal hand hygiene strategy in a university teaching hospital. Am J Infect Control. 2020;48(3):249–54.
Sadafi M, Bahmanpour K, Nouri B, Valiee S. Effect of multimodal intervention on nursing students’ adherence to hand hygiene: an experimental study. Creat Nurs. 2021;27(3):209–15.