Category Archives: Hygiene Promotion

WASHplus Weekly: Handwashing research in 2014

Issue 174| Jan 16, 2015 | Focus on Handwashing Research

A Summary of Handwashing Research in 2014 – The Global Public-Private Partnership for Handwashing (PPPHW)

In 2014, 26 peer reviewed handwashing studies that focused on developing countries were published.  Global PPPHW Secretariat Director Layla McCay prepared this summary and Pavani Ram, University at Buffalo, reviewed it. WASHplus Knowledge Resources Specialist Dan Campbell conducted the literature search. handwashing

What We Have Learned about Handwashing in 2014: A Summary

Measurement of handwashing behavior: Based on a review of numerous studies using structured observation to measure behavior, hands are washed with soap after approximately 19 percent of events that involved using the toilet or coming into contact with a child’s excreta.1

Behavior change communication: The much-awaited results from the Super-Amma campaign, a handwashing behavior change intervention based on emotional drivers such as nurture and disgust, have started to come in. These results show that this approach to handwashing promotion has lasting impact and is achieving the diffusion of handwashing as a social norm.2, 3 The campaign provides further confirmation that the knowledge of handwashing benefits is linked to its practice4, 5 and that women’s participatory groups6 and handwashing education in schools,7 including students’ involvement in hygiene and sanitation clubs,9 are good settings in which to build that knowledge into action. Furthermore, the mere act of checking whether households have soap seems to increase their handwashing behavior.10

Handwashing hardware: The studies reviewed provide further evidence that the availability of appropriate handwashing stations and soap in schools,7 healthcare centers,8 and in the home12, 13 increases handwashing prevalence, as does having piped water and functioning sewage mechanisms.14 Research provided further evidence that soap and ash are equally effective at cleaning hands,15 and that 4g of moringa oleifera leaf powder shows promise as an effective alternative to soap or ash for handwashing.16

Benefits of handwashing: A review estimated that handwashing with soap reduces the risk of diarrhea by 40 percent.1 Excluding the studies that could theoretically have been biased (or unblinded)—researchers knowing which people were exposed to handwashing interventions and which were not— handwashing with soap was estimated to reduce the risk of developing diarrhea by 23 percent.1 Further evidence showed that having soap in the home reduces children’s episodes of diarrhea, acute respiratory infections, eye infections, helminth infections, and school absences.18,19,20,21 It was found that good handwashing interventions in school also reduce school absences (but only for girls in one study)7 and that school-based interventions reduce episodes of diarrhea in preschool-aged siblings.17

Contamination: Various studies measured hands contaminated with rhinovirus,22 E coli,5, 25and helminth eggs.23 One study inversely correlated prevalence of handwashing with the amount of influenza virus found on household surfaces.24 A final study showed that in the rural areas hands revert to baseline levels of contamination within one hour after handwashing with soap.26

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Handwashing article receives the Elsevier Atlas award

Elsevier, a world-leading publisher and provider of information solutions for science, health, and technology professionals selected the Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial, The Lancet Global Health, March 2014 article to receive the Elsevier Atlas award. lshtm

Each month a single Atlas article is selected from published research from across Elsevier’s 1,800 journals by an external advisory board made up of individuals from NGOs including the following organizations, among several others:

• Food and Agricultural Organization (FAO)
• Health Informational for all – HIFA 2015
• International Training and Outreach Center in Africa (ITOCA)
• TEDMED
• United Nations Environmental Program (UNEP)
• University of California, Berkeley (Centre for Effective Global Action)
• Global Health Policy Institute
• United Nations University
• OXFAM
• Bioversity International

Atlas articles showcase research that can (or already has) significantly impact people’s lives around the world and we hope that bringing wider attention to this research will go some way to ensuring its successful implementation.

David Neal: Handwashing and the Science of Habit, Dec 4, 2014

David Neal: Handwashing and and the Science of Habit, December 4, 2014. This webinar was organized by WASHplus and the Public-Private Partnership on Handwashing.

Social and psychological impact of limited access to sanitation: The link between MHM and reproductive tract infections, and between WASH practices and pregnancy

Social and psychological impact of limited access to sanitation: The link between MHM and reproductive tract infections, and between WASH practices and pregnancy, October 2014. SHARE, WSSCC.

The approach utilizes a baseline cross-sectional survey to quantify  WASH practices and reported health history among a randomly-selected subset of girls and women from each of the four life-course groups in tribal, rural, and urban areas of Odisha, and a set of overlapping sub-studies each testing focused hypotheses about pathways between sanitation access, SRPS, hygiene behaviour and health.

Some Key Findings (for Practitioners):

  • While most sanitation challenges are universal for women, their  relative severity and frequency differed in urban, rural, and tribal areas and among young women, married women, and older adults. Strategies for improving latrine access and use could potentially utilize context-specific promotional strategies to
    encourage behaviour change.
  • Sanitation encompasses much more than defecation, specifically  within the Indian context. The act of defecation is embedded within other behaviours, including post-defecation cleaning, ritual bathing, and changing clothing; as well as menstrual management and urination. Strategies to improve sanitation
    coverage in India must be aware of how defecation practices are positioned within these larger behavioural patterns and responsive strategies are needed in order to facilitate adoption and use of sanitation technologies.

Oct 29, 2014 – The 3rd Annual Menstrual Hygiene Management (MHM) in WASH in Schools Virtual Conference

The 3rd Annual Menstrual Hygiene Management (MHM) in WASH in Schools Virtual Conference, Wednesday 29 October 2014

The 3rd virtual MHM in WinS conference will build on the content and recommendations of the prior two conferences and continue the effort to fill in the gaps in the existing knowledge and advocacy around this important issue. The one-day conference will bring together academics and health, gender, education, and water, sanitation and hygiene (WASH) experts from around the world currently implementing MHM-related activities.

Conference objectives:

  • To share recent research findings that relate to various aspects of MHM in WinS
  • To highlight school-based MHM program descriptions and their potential for scale
  • To share recommendations about how new MHM programs can be developed by WinS practitioners

What to do with infant poo? The blind spot of the blind spot

After a few years researching and working on sanitation, I feel (felt) that I have a good knowledge about the topic, or at least good knowledge of most of it and a clear picture of the areas I should learn more about. Moreover as a shit-worker I –and probably most of us in the sector– have developed a sort of pride or even vanity about being a herald of a neglected cause…

Last week at the UNC Water and Health Conference I was humbled and even slightly embarrassed when I ‘discovered’ the world of children’s faeces in an exciting side session: “What to Do with Infant Poo? Evidence-based Programming to support safe disposal of young children’s faeces”. Convened by WSP, UNICEF and USAID / WASHPlus Project, the session included presentations of experiences from Kenya, Bangladesh and Cambodia, followed by group work on ways forward. infant_poo

It is not that I ignored everything about child faeces; I had read something, had had some coincidental observations while staying in Indian villages, where I also included the issue partially in household surveys by gathering information of individuals’ defecation practices. But overall my knowledge was limited to the fact that child faeces have more pathogens than adult shit, and therefore should be disposed of safely; I had not fully acknowledged the complexities of the issue and kind of took for granted that improvements in adult sanitation would automatically lead to better management of child faeces. I was thus struck by a study in Bangladesh (by ICDDR,B), a country where adult open defecation is minimal, that showed that only 11-14% of children’s faeces are disposed of in latrines.

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Validity of Rapid Measures of Handwashing Behavior: An Analysis of Data from Multiple Impact Evaluations

Validity of Rapid Measures of Handwashing Behavior: An Analysis of Data from Multiple Impact Evaluations in the Global Scaling Up
Handwashing Project, 2014. Water and Sanitation Program.

Authors: Pavani K. Ram, Michelle W. Sahli, Benjamin Arnold, John M. Colford, Claire Chase, Bertha Briceño, Alexandra Orsola-Vidal, and Paul Gertler

This multicountry analysis has shown that observation of handwashing materials at the places where people wash hands, at the times most necessary for washing (after fecal contact and before food preparation), is a valid measure of handwashing with soap in multiple cultural and geographic contexts. There continues to be an overarching need for developing valid measures of handwashing behavior that can be collected in an efficient and inexpensive fashion. The structured observation data indicating low rates of soap use for handwashing at times of pathogen transmission reinforce the global imperative to improve handwashing behavior for prevention of the leading causes of death in young children.