A national survey of Ghanaian mothers, found that as few as 4% of mothers engaged in handwashing with soap after defecation, and only 2% after cleaning a child's bottom. In a multivariate analysis, the determinants of handwashing at these key junctures, with and without soap were examined. After defecation, mother's education, knowledge of important times to handwash with soap, the age of her children, and a measure of the quality of child care were all associated with handwashing. Only the latter two variables also predicted soap use amongst handwashers. After cleaning a child's bottom, education, knowledge of important times to handwash with soap, and child care quality were associated with handwashing yet only one variable, a measure of disgust sensitivity, showed any relationship with soap use. Health Policy Plan. 2007;22(4):216-24. Epub 2007 May.