Hand Hygiene Compliance Among Caregivers of Young Children in Rural Setting in Northern Malawi: A Cross‐Sectional Analytical Study

Background Hand hygiene remains a challenge in rural communities reliant on boreholes, worsened by nonfunctional water points. This study investigated hand hygiene compliance among caregivers of young children in rural setting in Ehehleni Community, Mzimba District. It also applied the COM‐B behavioral model to understand how structural, motivational, and environmental factors interact to influence compliance. Methods A cross‐sectional analytical study with a quantitative approach was conducted. Using systematic random sampling, data were collected from 350 caregivers via a paper‐based questionnaire and observational checklist. Data were analyzed using SPSS version 26 to determine relationships between variables, frequencies, and predictors of hand hygiene knowledge and practice. Results Among caregivers, 38% were aged 28–37 years. About 93% had moderate knowledge of hand hygiene, significantly predicted by household size ( p = 0.024). However, only 3% practiced good hand hygiene, which was not influenced by age ( p = 0.493), education ( p = 0.792), occupation ( p = 0.187), or household size ( p = 0.343). No caregivers had a designated handwashing facility, and 46% lacked a specific handwashing place. While 51% had soap, 96% cited inadequate sanitation infrastructure as a barrier, and 81% reported washing hands due to fear of illness. Conclusion Hand hygiene compliance among caregivers is critically low, despite moderate knowledge, indicating a substantial knowledge–practice gap. Targeted interventions, including caregiver training, improved access to handwashing supplies, and integration of hygiene education into routine health services, are needed to improve child health outcomes in low‐resource settings.