Changes in handwashing knowledge, attitudes, and practices among primary schoolchildren in Ulaanbaatar, Mongolia during the COVID-19 pandemic

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the critical importance of handwashing as a preventive measure against the spread of SARS- CoV-2. This study aimed to assess changes in handwashing knowledge, attitudes, and practices (KAP) among primary schoolchildren in Ulaanbaatar, Mongolia, before and during the pandemic.

Methods: A longitudinal study was conducted with 399 children aged 8-11 years, with data collected in December 2019 (pre-pandemic) and January 2021 (during the pandemic). A self-reported questionnaire was used to assess the children's handwashing KAP, focusing on four critical moments for handwashing: after using the toilet, before eating, after touching visibly dirty or unhygienic things, and after coming home.

Results: The results showed a significant increase in handwashing knowledge and attitudes during the pandemic, with the average knowledge score rising from 9.8 to 12.3 and the percentage of correct responses about critical handwashing moments increasing from 23.0 to 80.4%. Handwashing practices also improved, with an increased frequency of handwashing at critical moments, although practice before eating remained unchanged. Sociodemographic factors, such as sex, grade level, and parental education, were associated with handwashing behaviors. Girls were significantly more likely to engage in proper handwashing (AOR = 4.50, p < 0.01), while fourth-grade students showed higher odds of practicing proper handwashing than third-grade students (AOR = 5.27, p < 0.01). Fathers' higher education and maternal self-employment were positively associated with proper handwashing, whereas fathers' employment in public service was negatively associated. The overall KAP scores showed a significant increase during the pandemic, with a mean difference of 3.68 [95% CI = (4.06, 3.29), p < 0.01], indicating a notable improvement in handwashing behavior.

Discussion: These findings highlight the importance of health education and interventions in shaping children's hygiene behaviors during global health crises, with lasting implications for public health strategies, particularly in resource-limited settings.

Keywords: COVID-19; Mongolia; handwashing; knowledge, attitude, and practice (KAP); schoolchildern.

Figure 1

First 817 children assessed for eligible for the study to participate. Before the start of the data collection, an informed consent session was held in a classroom which the study purpose and procedure were explained. Before the pandemic data was collected from a total of 748 participants and during the pandemic was collected a total of 507 participants, respectively. As a result of data cleaning process, a total of 412 participants data were remained which are completely attended both phases.

Figure 2

Handwashing practices: 4 critical moments before and during the pandemic. Bar graph illustrates self-reported handwashing behavior at four key moments: after coming home, after touching visibly dirty things, after using the toilet, and before eating. Responses are categorized into four frequencies: “always,” “usually,” “sometimes,” and “never.” This figure illustrates self-reported handwashing behaviors at four key moments: after coming home, after touching visibly dirty things, after using the toilet, and before eating. Comparisons between behaviors before and during the pandemic are shown for each moment, Statistically significant improvements in handwashing frequency during the pandemic are observed in three of the four situations (p < 0.05), except for after using the toilet (p = 0.19).