BACKGROUND Limited data have been available on the global practice of handwashing with soap (HWWS). To better appreciate global HWWS frequency, which plays a role in disease transmission, our objectives were to: (i) quantify the presence of designated handwashing facilities; (ii) assess the association between handwashing facility presence and observed HWWS; and (iii) derive country, regional and global HWWS estimates after potential faecal contact. METHODS First, using data from national surveys, we applied multilevel linear modelling to estimate national handwashing facility presence. Second, using multilevel Poisson modelling on datasets including both handwashing facility presence and observed HWWS after potential faecal contact, we estimated HWWS prevalence conditional on handwashing facility presence by region. For high-income countries, we used meta-analysis to pool handwashing prevalence of studies identified through a systematic review. Third, from the modelled handwashing facility presence and estimated HWWS prevalence conditional on the presence of a handwashing facility, we estimated handwashing practice at country, regional and global levels. RESULTS First, approximately one in four persons did not have a designated handwashing facility in 2015, based on 115 data points for 77 countries. Second the prevalence ratio between HWWS when a designated facility was present compared with when it was absent was 1.99 (1.66, 2.39) P <0.001 for low- and middle-income countries, based on nine datasets. Third, we estimate that in 2015, 26.2% (23.1%, 29.6%) of potential faecal contacts were followed by HWWS. CONCLUSIONS Many people lack a designated handwashing facility, but even among those with access, HWWS is poorly practised. People with access to designated handwashing facilities are about twice as likely to wash their hands with soap after potential faecal contact as people who lack a facility. Estimates are based on limited data.

中文翻译：

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潜在的粪便接触后用肥皂洗手：全球，区域和国家估计。

背景技术关于用肥皂洗手的全球实践（HWWS）的数据有限。为了更好地了解在疾病传播中起作用的全球HWWS频率，我们的目标是：（i）量化指定洗手设施的存在；（ii）评估洗手设施的存在与观察到的HWWS之间的关联；（iii）在潜在的粪便接触后得出国家，地区和全球的HWWS估算值。方法首先，我们使用来自国家调查的数据，应用多层线性建模来估计国家洗手设施的存在。其次，在数据集上使用多级Poisson建模，包括洗手设施的存在和潜在粪便接触后观察到的HWWS，我们按区域估算了以洗手设施的存在为条件的HWWS患病率。对于高收入国家，我们使用荟萃分析汇总了通过系统评价发现的洗手患病率。第三，根据建模的洗手设施的存在和估计的HWWS普及率（以洗手设施的存在为条件），我们估算了国家，地区和全球各级的洗手实践。结果首先，根据77个国家/地区的115个数据点，大约四分之一的人在2015年没有指定的洗手设施。其次，根据九个数据集，对于低收入和中等收入国家，有指定设施存在时与没有设施时相比，HWWS之间的患病率是1.99（1.66，2.39）P <0.001。第三，我们估计在2015年，HWWS追踪了26.2％（23.1％，29.6％）潜在的粪便接触者。结论许多人缺乏指定的洗手设施，但是即使在有访问权限的人群中，HWWS的实践也很差。可以使用指定洗手设施的人在潜在的粪便接触后用肥皂洗手的可能性是缺少洗手设施的人的两倍。估算基于有限的数据。