Household Water and Handwashing Facilities and Early Childhood Education Participation in Nepal: Evidence From a Nationally Representative Cross‐Sectional Survey

Background and Aims: Early childhood education (ECE) is crucial for cognitive, social, and emotional development. Household water, sanitation, and hygiene (WASH) may influence ECE enrollment, but their role in Nepal is unclear. This study examined associations between household water and handwashing facilities and ECE participation among children aged 3-4 years, accounting for rural-urban and socioeconomic factors. Methods: This cross-sectional study used nationally representative secondary data from the Nepal Demographic and Health Survey (NDHS) 2022, including 1057 children aged 3-4 years. Descriptive analyses, survey-weighted multivariable logistic regression, and stratified analyses were employed according to rural-urban residence. Additionally, spatial mapping was used to examine geographical variation in ECE participation. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC). All results were reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: Overall, 78.7% of children participated in ECE. Improved water sources, treated water, and handwashing facilities were associated with higher enrollment in bivariate analyses. After adjustment, household media access (aOR:5.17; 95% CI:2.04-13.10) and urban wealth (aOR: 2.61; 95%CI:1.04-6.52) remained significant. The predictive model showed excellent discrimination (AUC = 0.957). Provincial disparities existed, with Karnali and Koshi higher and Gandaki lower. Conclusion: Media contact drives ECE enrollment, whereas WASH effects appear attenuated after accounting for socioeconomic and maternal factors. Improving maternal education and media-based awareness may enhance ECE participation, especially in rural areas.