title: Current knowledge, attitude and behaviour of hand and food hygiene in a developed residential community of Singapore: a cross-sectional survey.
abstract: BACKGROUND
  Diarrhoea incidence has been increasing progressively over the past years in developed countries, including Singapore, despite the accessibility and availability to clean water, well-established sanitation infrastructures and regular hygiene promotion. The aim of this study is to determine the current knowledge, attitude and behaviour of hand and food hygiene, and the potential risk factors of diarrhoea in a residential community of Singapore.
  
  
  METHODS
  A cross-sectional study was conducted within a residential area in the west of Singapore from June to August 2013. A total of 1,156 household units were randomly sampled and invited to participate in an interviewer-assisted survey using standardised questionnaires. Descriptive, univariate and multivariate analyses were performed using descriptive statistics, Fisher's Exact test and multivariate logistic regression modelling, respectively. R program was used for all statistical analysis. All tests were conducted at 5% level of significance with 95% confidence intervals (CI) reported where applicable.
  
  
  RESULTS
  A total of 240 units (20.8%) consented and responded to the survey invitation. About 77% of the expected knowledge and attitude were observed in at least 80% of the participants, compared to only about 31% of the expected behaviours and practises. Being single [adjusted odds ratio (AOR) = 2.29; 95% CI = 1.16-4.48], having flu in the past six month (AOR = 3.24; 95% CI = 1.74-6.06), preferred self-medication (AOR = 2.07; 95% CI = 1.06-4.12) were risk factors of diarrhoea. Washing hands with water before attending to children or sick persons (AOR = 0.30; 95% CI = 0.11-0.82), washing hands with water (AOR = 0.16; 95% CI = 0.05-0.45) and water with soap (AOR = 0.29; 95% CI = 0.12-0.72) after attending to children or sick persons, and hand washing between 30 s to a minute (AOR = 0.44; 95% CI = 0.20-0.90) were protective factors against diarrhoea.
  
  
  CONCLUSIONS
  Good knowledge and attitude of the participants did not positively translate into high compliance and motivation to perform good hygiene practices. This observation may have resulted in a significant extent on the increasing diarrhoea incidences. Current interventions may be improved with more active community partnership among the residents, schools and the relevant social organizations, to raise awareness on the importance of compliance to good hygiene practices, and the risk factors of diarrhoea. A large case-control study would be required to validate these findings in future.
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. Junxiong_Pang@nuhs.edu.sg.
authors.forename: Junxiong
authors.initials: J
authors.lastname: Pang
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. jonathan_lumen@nuhs.edu.sg.
authors.forename: Shao Wei Jonathan Lumen
authors.initials: SW
authors.lastname: Chua
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. hsuliyang@gmail.com.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. hsuliyang@gmail.com.
authors.forename: Liyang
authors.initials: L
authors.lastname: Hsu
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D005502:Food; D006225:Hand; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012499:Sanitation; D012846:Singapore / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires