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Why Most Mothers Wash Their Hands, But Child Diarrhea Rates Remain Stubbornly High​

June 19, 2025

Why Most Mothers Wash Their Hands, But Child Diarrhea Rates Remain Stubbornly High

  • Mary Akinwola, Global Program and Partnership Officer, SRHIN

Every morning, Bisola faithfully washes her hands before preparing breakfast for her three children in their Lagos home. She’s among the majority of Nigerian mothers who practice handwashing, a habit that should theoretically protect her family from waterborne diseases. According to the Nigerian Bureau of Statistics, 91.4% of household heads know of handwashing times, and handwashing practices have been widely promoted across the country. Yet despite this widespread practice, Nigeria still records some of the highest childhood diarrhea rates globally, with the disease claiming thousands of young lives annually. This is Nigeria’s handwashing paradox, and the answer can be found in the gap between intent and impact. Epidemiologists call this the knowledge-practice-outcome gap, where high awareness fails to translate into measurable health improvements due to structural barriers and implementation challenges.

The numbers don’t add up. Recent studies show a troubling disconnect: while handwashing practices among Nigerian mothers have improved significantly, childhood diarrheal diseases remain persistently high. The Centers for Disease Control and Prevention confirms that proper handwashing with soap can reduce diarrhea risk by at least 40%, yet this theoretical protection isn’t translating into results for Nigerian families. The typical culprit would be a lack of knowledge about hygiene but most mothers understand that hand washing prevents disease. The issue is in the timing, technique, and key moments that many families miss entirely.

Research shows that handwashing effectiveness depends on five specific moments: after using the toilet, after handling child feces, before eating, before feeding children, and before food preparation. This is where the paradox deepens. Research in Port Harcourt report that while mothers wash their hands regularly, they often miss these windows (Opara et al., 2017). A mother might wash her hands in the morning but forget to do so after changing a diaper or before preparing her child’s meal. These missed moments create infection pathways that bypass all the good hand-washing habits practiced at other times.

The Five Critical Moments for Hand Hygiene

There is an even bigger issue, and this is the gap in access to soap and water. Even when the timing is right, technique matters enormously. This technique is most effective when implemented with the right resources. According to Nigeria’s Multiple Indicator Cluster Survey (MICS) 2021, only 29.7% of the population has handwashing facilities where both water and soap are available. More troubling, World Bank data indicates that 167 million Nigerians lack access to basic handwashing facilities, while UNICEF reports show that access to basic hand washing facilities actually declined from 21% in 2018 to 16% in 2019. Observations show that many Nigerian households still rely on shared bar soap or use water alone, both of which reduce effectiveness. Shared soap bars can harbor bacteria and viruses, while water without soap fails to remove the pathogens that cause diarrheal diseases. This challenge is fundamentally economic and a poverty penalty. The economic reality is that liquid soap, while more hygienic than shared bar soap, is expensive for many families, creating a cost-benefit calculation that prioritizes affordability over maximum protection. With an increase in inflation over the last five years, the highest since March 1996 (National Bureau of Statistics), economic constraints create a health vulnerability that persists despite good intentions.

Further, in communities where water access is inconsistent or sanitation infrastructure is poor, maintaining perfect hand-washing habits faces limitations. When families lack reliable water sources or live in areas with inadequate waste management, the effectiveness of hand washing diminishes significantly. This environmental factor explains why handwashing campaigns focused solely on behavior change often fall short of the disease reduction goals.

Breaking this paradox requires precision. This is what the Slum and Rural Health Initiative does through BetaMama Pikin, an innovative maternal and child hygiene project. Operating in Nigeria’s most underserved communities, the initiative has documented how promoting hygiene during pregnancy, childbirth, and postnatal care needs education and systematic infrastructure support. BetaMama Pikin employs sustainable and engaging approaches, utilising locally translated materials and jingles, to facilitate educational sessions that promote engagement among healthcare workers and expectant and nursing mothers across four states in Nigeria. SRHIN’s work in these communities highlight that families often understand hygiene principles but lack the basic infracture to implement them consistently. Water access is intermittent, soap is economically prohibitive, and sanitation facilities are shared or inadequate, as a result, even the most motivated mothers face insurmountable structural barriers. The system sets people up for failure.

Similar to BetaMama Pikin, health programs should focus on the five critical moments, providing practical tools like timers or visual reminders to help families remember these key times. Community health workers can demonstrate the proper technique using affordable alternatives like baking soda when commercial soap isn’t accessible.

At the policy level, Nigeria requires integrated approaches that combine handwashing promotion with improved access to water and sanitation infrastructure. Effective interventions must operate across multiple levels, from individual (skill-building and motivation), household (resources), community (social norms and support systems), to policy (regulation and resource allocations).

BetaMama Pikin, supported by the Oyo State Primary Healthcare Board, welcomes this structure. There is a greater need for programs to address the economic barriers that force families to choose between effective hygiene products and other essential necessities.

Bisola’s experience is that of many. This handwashing spotlights broader challenges in translating health knowledge into positive population outcomes. Solutions must be tailored, not one-size-fits-all. So, for Nigerian families, our message is clear: handwashing works, but only when practiced at the right moments with the right technique. We must prioritize handwashing after any contact with feces, before food-related activities, and ensure that soap or effective alternatives are always available.

For policymakers and health officials, this bridge of knowledge and proper application demands smarter and integrated programming that addresses structural barriers alongside behavioral change. Instead of celebrating handwashing adoption rates, there is a need to focus on measuring handwashing at key times and addressing the structural barriers that limit effectiveness.

Children and mothers deserve the full protection that proper handwashing can provide. Closing the gap between practice and protection means creating conditions where good behavior can achieve its intended results. The issue surrounding handwashing can be addressed, but only if we’re willing to look beyond the surface and tackle the deeper factors that prevent good intentions from saving lives.

References

  1. Centers for Disease Control and Prevention. (2024, April 17). Handwashing Facts. Clean Hands. https://www.cdc.gov/clean-hands/data-research/facts-stats/index.html
  2. National Bureau of Statistics . (2024). CPI and Inflation Report| National Bureau of Statistics. Nigerianstat.gov.ng. https://www.nigerianstat.gov.ng/elibrary/read/1241453
  3. National Bureau of Statistics & Federal Ministry of Water Resources. (2024). Reports | National Bureau of Statistics. Nigerianstat.gov.ng. https://www.nigerianstat.gov.ng/elibrary/read/950
  4. Opara, P., Alex-Hart, B., & Okari, T. (2017). Hand-washing practices amongst mothers of under-5 children in Port Harcourt, Nigeria. Paediatrics and International Child Health, 37(1), 52–55. https://doi.org/10.1179/2046905515y.0000000061
  5. UNICEF. (2021). On Global Handwashing Day, UNICEF warns that 3 in 5 Nigerians do not have basic handwashing facilities at home to fight off infectious diseases. Www.unicef.org. https://www.unicef.org/nigeria/press-releases/global-handwashing-day-unicef-warns-3-5-nigerians-do-not-have-basic-handwashing
  6. UNICEF. (2022). Hand washing, key to delivering quality healthcare services to Nigeria’s children and women.Www.unicef.org. https://www.unicef.org/nigeria/stories/hand-washing-key-delivering-quality-healthcare-services-nigerias-children-and-women

7. World Bank. (2021, May 26). Nigeria: Ensuring water, sanitation and hygiene for all. World Bank.https://www.worldbank.org/en/news/feature/2021/05/26/nigeria-ensuring-water-sanitation-and-hygiene-for-all

Share this article to raise awareness. Join SRHIN in advocating for integrated WASH policies in Nigeria. Click below to learn more about the BetaMama Pikin Initiative

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