Assessing the environmental context of hand washing among school children in Limpopo, South Africa

Despite its simplicity and efficacy, the promotion of hand washing for disease prevention remains a challenge, particularly in resourcelimited settings. This article reports on a quasi- experimental schoolbased study that aimed to improve habitual hand washing. Significant increases in hand washing occurred following improvements in hygiene and sanitation facilities (School A: t = 13.86, p = 0.0052). Smaller increases in hand washing occurred following education (School A: t = 2.63; p = 0.012; School B, no infrastructure improvements: t = 1.66, p = 0.239). Health policy and programming need to pay greater attention to the interplay of the structural, social and individual dimensions of unique contextual environments that influence habitual behaviours.