Household determinants of observed handwashing among primary schoolchildren in Hebron, Palestine: a cross-sectional study

Objective To assess observed handwashing before eating among primary schoolchildren in a fragile setting in Palestine and examine how this behaviour is associated with household-level and guardian-related determinants. Design Cross-sectional baseline study embedded within a school-based cluster randomised controlled trial of a hand hygiene intervention.

The trial is registered on ClinicalTrials.gov ( NCT05964478 ), and this manuscript reports pre-results baseline findings alongside additional cross-sectional household survey data. Setting Public primary schools in rural and semiurban areas of the Hebron governorate, Palestine, February–March 2023.

Participants Fifth and sixth grade schoolchildren enrolled in the trial and their co-resident guardians. Children were observed at school and guardians completed a questionnaire at home.

Primary and secondary outcome measures The primary outcome was observed handwashing of both hands with water before eating at school, recorded by trained enumerators during a standardised snack break. Household-level and guardian-level determinants were derived from a structured questionnaire covering five domains: sociodemographic characteristics of guardian and child; household access to handwashing; guardian’s health and handwashing knowledge; guardian’s self-reported handwashing behaviour; and guardian-reported child handwashing at home.