Uptake of hand washing with soap or soapy water from a large-scale cluster randomized community trial in urban Bangladesh

ICDDRB Health & Science Bulletin, 10(4) Dec 2012

Uptake of hand washing with soap or soapy water from a large-scale cluster randomized community trial in urban Bangladesh (pdf)

Small-scale studies have shown that intensive hand washing promotion reduces disease, but there is little evidence that largescale hand washing promotion programs change behaviour. We deployed a community-based hand washing promotion intervention and used the presence of water and soap or soapy water at hand washing stations as a proxy indicator for hand washing behaviour and found encouraging results. A cluster randomized cholera vaccine trial conducted in a low-income urban area of Dhaka included those who received the vaccine only (Vaccine Only group), those who received the vaccine and a hand washing and water treatment intervention (Vaccine+HWT group), and those who were neither vaccinated nor received the intervention (Control group). Among the Vaccine+HWT group, the presence of water and soap or soapy water at the hand washing place increased from 22% (41/190) at baseline to 60% (102/171) at the 11-month assessment point (p<0.001). We found no significant increase in the presence of water and soap or soapy water among the Control group or the Vaccine Only group during the same period.

Our findings suggest that hand washing behaviour changed following implementation of a large-scale intervention in a low-income urban setting that provided hardware to enable hand washing and encouraged regular hand washing. Further research on health impact of hand washing with soap in this community and the sustainability of using soapy water could help optimize recommendations for improving hand washing practices in other low-income communities.