AUTHOR=Maani-Abuzahra Yaman , Winkler Mirko S. , Hattendorf Jan , Galli Anaïs , Tamas Andrea , Abdulkarim Zainab , Kolo Usman Modu , Shuaibu Muhammad Auwal , Peter Maryna , Probst-Hensch Nicole , N. Owen Branwen 
  
TITLE=Baseline Assessment of Handwashing Behavior, Hand Hygiene Conditions, and Wellbeing in Primary Schools in Nigeria
  
JOURNAL=International Journal of Public Health
  
VOLUME=Volume 70 - 2025
  
YEAR=2025
  
URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2025.1608656
  
DOI=10.3389/ijph.2025.1608656
  
ISSN=1661-8564
  
ABSTRACT=ObjectivesIn humanitarian settings, poor school hygiene conditions can severely impact children’s health and wellbeing. As part of a cluster randomized trial evaluating a multicomponent hand hygiene intervention, this baseline study assessed hand hygiene behaviors, school infrastructure, and wellbeing among schoolchildren in Nigeria.MethodsBetween May and June 2023, cross-sectional data were collected from 26 schools using handwashing observations, questionnaires, infrastructure assessments, and hand rinse sampling. A total of 964 children were observed, 645 interviewed, and 311 provided samples.ResultsObserved handwashing rates were extremely low: 4%–12% before eating and 2%–3% after toilet use. About half of schools lacked designated handwashing stations. General water points, though more available, were often inadequate. Soap was entirely absent. Over half of children’s hands rinse samples contained more than 100 colony-forming units (CFU) of Escherichia coli (E: coli) per 100 mL. Misconceptions about hygiene were widespread and gaps existed between reported and observed behavior.ConclusionThese findings underscore the need for integrated school-based WASH interventions in humanitarian contexts.