摘要：Objectives. We assessed hand-washing behaviors and intentions among school children in Bogotá, Colombia, to help identify and overcome barriers to proper hygiene practices. Methods. Data on hand-washing behavior and intentions and individual and contextual factors were collected from 2042 sixth- through eighth-grade students in 25 schools in Bogotá via anonymous questionnaires. A member of the school administration or teaching staff completed a questionnaire about the school environment. Site inspections of bathroom facilities were conducted. Results. Only 33.6% of the sample reported always or very often washing hands with soap and clean water before eating and after using the toilet. About 7% of students reported regular access to soap and clean water at school. A high level of perceived control was the strongest predictor of positive hand-washing intentions (adjusted odds ratio [AOR] = 6.0; 95% confidence interval [CI] = 4.8, 7.5). Students with proper hand-washing behavior were less likely to report previous-month gastrointestinal symptoms (OR = 0.8; 95% CI = 0.6, 0.9) or previous-year school absenteeism (OR = 0.7; 95% CI = 0.6, 0.9). Conclusions. Scarcity of adequate facilities in most schools in Bogotá prevents children from adopting proper hygienic behavior and thwarts health promotion efforts. The current renovation program of public schools in Bogotá provides a unique opportunity to meet the challenges of providing a supportive environment for adoption of healthy behaviors. Remarkable improvements have been made in the past century in the fight against communicable diseases, yet a significant amount of mortality and morbidity worldwide can still be attributed to these conditions. 1 Respiratory infections and diarrheal diseases—the 2 leading causes of disease burden globally—are responsible for half of all child deaths each year. 1 The burden of communicable disease remains predominantly acute in developing regions of the world, 2 and children remain particularly vulnerable. 3 Recent estimates in Colombia indicate that acute respiratory and intestinal infections are the main cause of mortality among children aged 1 to 4 years, the second leading cause of death among girls aged 5 to 14 years, and the third leading cause of infant mortality. 4 According to a recent national household survey in Colombia, 14.1% and 9.6% of children younger than 5 years had experienced diarrhea or an acute respiratory infection, respectively, in the 2 weeks before the survey. 4 Despite much evidence supporting the effectiveness of measures such as vaccination, 5 , 6 improvement in sanitary conditions, 3 , 6 and basic hygiene practices 3 – 7 in controlling communicable diseases, many developing nations have yet to achieve effective vaccination coverage 6 and remain plagued with poor sanitary conditions. Basic personal hygiene behaviors, such as hand washing, are still not widely practiced. 7 Diverse health behavior and social marketing theories have been applied in the design and implementation of behavioral change interventions that promote infection-control practices. 8 , 9 The theory of reasoned action and planned behavior, 10 , 11 for example, suggests that a person's behavior is determined by her or his intention to perform the behavior. Intention, in turn, is a function of the person's attitudes toward the behavior, beliefs concerning benefits or harms of adopting or not adopting the behavior, subjective norms and normative beliefs, and perceived control over the opportunities, resources, and skills necessary to perform the behavior. 9 , 10 More recently, ecological approaches have been incorporated into behavioral theories to disentangle independent effects of individual and contextual factors on health behavior. 12 The underlying premise of such models is a bidirectional relation between environmental modifications and behavioral change. 12 , 13 Bearing in mind that school children have been consistently implicated in the spread of communicable diseases 14 and that the school has been recognized as a vital setting for health promotion, we assessed the prevalence and individual and contextual determinants of proper hand-washing behavior and positive hand-washing intentions among school children in Bogotá, Colombia.
