Changes in Handwashing Knowledge, Attitudes, and Practices Among Primary Schoolchildren in Ulaanbaatar, Mongolia During the COVID-19 Pandemic

Munguntuul Enkhbat^1*Ganchimeg Togoobaatar²Oyunchimeg Erdenee³Katsumata Asako Takekuma⁴

• ¹Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
• ²School of Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
• ³National Center for Communicable Diseases, Ulaanbaatar, Mongolia, Ulaabaatar, Mongolia
• ⁴University of Shizuoka, Shizuoka, Shizuoka, Japan

The COVID-19 pandemic has highlighted the critical importance of handwashing as a preventive measure against the spread of SARS-CoV-2. This study aimed to assess changes in handwashing knowledge, attitudes, and practices (KAP) among primary schoolchildren in Ulaanbaatar, Mongolia, before and during the pandemic. A longitudinal study was conducted with 399 children aged 8 -11 years, with data collected in December 2019 (pre-pandemic) and January 2021 (during the pandemic). The self-reported questionnaire assessed children's handwashing knowledge, attitudes, and practices, with a focus on four critical moments for handwashing: after using the toilet, before eating, after touching visibly dirty or unhygienic things, and after coming home.Results showed a significant increase in handwashing knowledge and attitudes during the pandemic, with the average knowledge score rising from 9.8 to 12.3 and the percentage of correct responses about critical handwashing moments increasing from 23.0% to 80.4%. Handwashing practices also improved, with an increased frequency of handwashing at critical moments, although practice before eating remained unchanged. Sociodemographic factors, such as sex, grade level, and parental education, were associated with handwashing behaviors. Girls were significantly more likely to engage in proper handwashing (AOR = 4.50, p < 0.01), while fourthgrade students showed higher odds of practicing proper handwashing than third-grade students (AOR = 5.27, p < 0.01). Fathers' higher education and maternal self-employment were positively associated with proper handwashing, whereas fathers' employment in public service was negatively associated. The overall KAP scores showed a significant increase during the pandemic, with a mean difference of 3.68 (95% CI = [4.06, 3.29], p < 0.01), indicating a notable improvement in handwashing behavior. These findings highlight the importance of health education and interventions in shaping children's hygiene behaviors during global health crises, with lasting implications for public health strategies, particularly in resource-limited settings.