Hygiene Practices and Early Childhood Development in the East Asia-Pacific Region: A Cross-Sectional Analysis

Fanny Petermann-Rocha; Nirmala Rao; Manya Bala; Monika Parshad-Asnani; Anthony Sifuna; Aisha Yousafzai; Frederick K Ho; Patrick Ip

doi:10.3390/ijerph20042798

Hygiene Practices and Early Childhood Development in the East Asia-Pacific Region: A Cross-Sectional Analysis

Int J Environ Res Public Health. 2023 Feb 4;20(4):2798. doi: 10.3390/ijerph20042798.

Authors

Fanny Petermann-Rocha^{1

2}, Nirmala Rao³, Manya Bala³, Monika Parshad-Asnani⁴, Anthony Sifuna⁵, Aisha Yousafzai⁶, Frederick K Ho⁷, Patrick Ip⁸

Affiliations

¹ Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago 8370068, Chile.
² BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK.
³ Faculty of Education, The University of Hong Kong, Hong Kong.
⁴ Sickle Cell Unit, Caribbean Institute for Health Research, The University of The West Indies, Kingston 7, Jamaica.
⁵ Department of Medical Biochemistry, Masinde Muliro University of Science and Technology, Kakamega 50100, Kenya.
⁶ Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02115, USA.
⁷ School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK.
⁸ Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong.

Abstract

Poor hygiene might be a risk factor for early childhood development (ECD). This study investigated the associations of three hygiene practices ('wash hands before a meal,' 'wash hands after going to the toilet,' and 'brush teeth'), separately and combined, with ECD. Six thousand six hundred ninety-seven children (4 [0.8] years) from the East Asia-Pacific Early Child Development Scales validation study were included in this cross-sectional analysis. The hygiene variables were recoded to have comparable values as 'always,' 'sometimes,' and 'never.' These variables were then grouped to create combined categories. The binary outcome variables, poor ECD, were defined as a score < age-specific 25th centile. Modified Poisson regression models were used to analyse the associations. Data collection was performed between 2012 and 2014, and the analyses were conducted in April 2022. Compared with children who 'always' washed their hands before a meal, those who did it 'sometimes' (Prevalence Ratio [PR]: 1.30 [95% CI: 1.16-1.46]) or 'never' (PR: 1.35 [1.18-1.55]) had a higher likelihood of poorer overall development. Comparable results were identified for the other two hygiene practices and the other four domain-specific outcomes (p < 0.05). Compared with children who always followed the three hygiene practices, the likelihood of poor overall ECD increased as the combined hygiene practice decreased among children with poor hygiene practices (PR_never: 1.67 [1.40-2.00]; PR_rarely: 1.49 [1.30-1.71]; PR_sometimes: 1.30 [1.14-1.49]). Children who did not always follow good hygiene practices had a higher likelihood of poor ECD independently of sociodemographic factors. Considering these findings, future hygiene practice interventions and trials should consider including ECD outcomes.

Keywords: East Asia-Pacific region; child; growth and development; hand hygiene; oral hygiene.

MeSH terms

Asia, Eastern
Child
Child Development*
Child, Preschool
Cross-Sectional Studies
Humans
Hygiene*
Prevalence
Risk Factors
Sanitation

Grants and funding

The data reported in this paper are based on a grant received by Nirmala Rao from UNICEF East Asia and Pacific Regional Office, the Asia-Pacific Regional Network for Early Childhood, and the Open Society Foundations. She was the PI for this study. The other authors received no additional funding.