title: The impact of gender and physical environment on the handwashing behaviour of university students in Ghana.
abstract: OBJECTIVE
  To establish levels of handwashing after defecation among students at the University of Cape Coast in Ghana, and to test hypotheses that gender and washroom environment affect handwashing behaviour.
  
  
  METHODS
  Data on students' handwashing behaviour after defecation were collected by structured observations in washrooms. Eight hundred and six observations were made (360 female students and 446 males) in 56 washrooms over 496 observation periods. Observers recorded gender, duration of handwashing, use of soap, and physical characteristics of the washroom (cleanliness, availability of soap, tap flow and presence of handwashing posters).
  
  
  RESULTS
  Fewer than half the students observed washed their hands or bathed after defecation. Of these, only two-thirds washed both hands and a minority (20%) used soap; only 16 students (all men) washed their hands for the recommended 15 s or longer. Female students were more likely to wash their hands at all, and were more likely to wash both hands, than males. Cleanliness of the washroom was strongly associated with improved handwashing behaviour for both women and men, as was tap flow quality for female students.
  
  
  CONCLUSIONS
  Handwashing behaviour is generally poor among UCC students, mirroring results from North American Universities. The findings underline the plasticity of handwashing behaviour among this population, and highlight the need for ensuring that the physical environment in washrooms on university campuses is conducive to handwashing.
authors.affiliation: Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana.
authors.forename: Simon
authors.initials: S
authors.lastname: Mariwah
authors.forename: Kate
authors.initials: K
authors.lastname: Hampshire
authors.forename: Adetayo
authors.initials: A
authors.lastname: Kasim
mesh_terms: D000328:Adult; D003672:Defecation; D005260:Female; D005869:Ghana; D006235:Hand Disinfection / Q000379:methods*; D015438:Health Behavior; D006266:Health Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012737:Sex Factors; D013334:Students / Q000706:statistics & numerical data*; D014495:Universities; D055815:Young Adult