Influence of Hygiene Practices among Caregivers on Diarrhoeal Diseases in Children Under-Five in Westlands, Nairobi, Kenya

Abstract

Diarrhoeal diseases remain a major cause of morbidity among children under five years of age, particularly in urban settings where everyday hygiene behaviours strongly influence exposure to infection. In such settings, caregiver practices play a critical role in either preventing or facilitating disease transmission. This study examined hygiene practices as determinants of diarrhoeal disease among under-five children in Westlands, Nairobi County, Kenya. A cross-sectional study design was used, involving 369 caregivers of under-five children. Data were collected using structured questionnaires for quantitative information, while qualitative data were obtained through focus group discussions and key informant interviews. Quantitative data were analysed using descriptive statistics and binary logistic regression, while qualitative data were analysed thematically. The findings showed that most caregivers reported good hygiene practices, including regular handwashing with soap (80.8%), availability of handwashing facilities within households (73.2%), and routine cleaning of the household environment (70.7%). Handwashing with soap was significantly associated with reduced odds of diarrhoeal disease among under-five children (AOR = 0.36, P = .004), indicating a strong protective effect. Conversely, children from households that cleaned their environment weekly were more likely to experience diarrhoeal disease compared with those in households that cleaned daily (AOR = 2.74, P < .001). Qualitative findings further revealed challenges that undermined optimal hygiene practices, including inconsistent handwashing behaviour, poor waste disposal practices, stagnant wastewater, and open drainage systems within the community. These conditions were reported to increase exposure to contamination and sustain diarrhoeal disease transmission. The study concluded that hygiene practices, particularly handwashing with soap and regular household cleaning, significantly reduced the risk of diarrhoeal disease among under-five children. To sustain these gains, public health actors should strengthen community-based behaviour change interventions that promote handwashing with soap at critical times, while improving household access to soap, water, and functional handwashing facilities.