World Bank targets smarter sanitation communication for rural Ethiopia

By Peter McIntyre, IRC Associate

The World Bank in Ethiopia has commissioned a rapid survey of what motivates people to upgrade their latrines, with the aim of delivering behaviour change communication materials with greater impact.

Sanitation rapid survey launch meeting Addis Abeba, 23 March 2017 (Photo: Sirak Wondimu)

The survey is being conducted in four regions, with the main target audiences being adult women, male heads of households, opinion leaders and existing sanitation businesses.

The aim is to pilot and produce materials that emphasise the dignity, prestige and status of having improved sanitation, rather than focusing only on health messages.

The WB decided a new approach was needed after Demographic and Health Survey (DHS) figures for 2016 suggested that only 4% of rural households in Ethiopia have improved toilets facilities while a further 2% have facilities that would be considered improved if they were not shared. This is well below the Joint Monitoring Program figure of 28% for improved latrines (although we understand this may be revised down to around 14%). Indeed, according to DHS, although access to some form of sanitation has risen, access to an improved latrine has declined in percentage terms over the past ten years. Most latrines in rural areas (55%) do not have an effective slab or lid while more than a third of rural households (39%) practise open defecation.

The Government of Ethiopia has a flagship programme to increase use of improved latrines to 82% by 2020.

At a launch meeting in Addis on 23 March 2017, social market consultant, Addis Meleskachew, said that this initiative will develop a memorable brand for marketing materials that will encourage the private sector to provide materials and will attract rural families to buy them.

Dagnew Tadesse,Hygiene and Environmental Health Case Team Leader for Ministry of Health, welcomed the initiative to attract business but emphasised that the GoE approach is based on a comprehensive health education strategy with multiple messages including hygiene awareness, handwashing and safe food, and said that these important messages should not be abandoned.

Jane Bevan, rural WASH Manager at UNICEF Ethiopia offered to share extensive data that UNICEF has collected for its country programme on attitudes to sanitation, which has identified the high cost of concrete slabs as a significant obstacle. She presented examples of low cost options for upgrading sanitation in a pilot project in Tigray region. It was agreed to collate all existing KAP studies and relevant data including research by SNV.

Monte Achenbach from PSI and John Butterworth from IRC spoke about the work being started by USAID Transform WASH to market innovative sanitation models. John Butterworth said there is a need to make people aware of what is available and to get materials to where they are needed.

The World Bank research is being conducted by 251 Communications.

This blog was originally posted on 5 April 2017 on the IRC website.

July to December 2016 Handwashing Research Summary – GHP

July to December 2016 Handwashing Research Summary, March 2017. Global Handwashing Partnership.

• Full text, pdf

Between July and December 2016, we identified 37 relevant peer-reviewed studies on handwashing.

Learn about key findings during this time period in this handwashing research summary from the second half of 2016.

Recently published handwashing studies

1 – Trop Med Int Health. 2017 Feb 28. doi: 10.1111/tmi.12861. [Epub ahead of print]

Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries.

OBJECTIVES: To synthesise evidence on the effect of handwashing promotion interventions targeting children, on diarrhoea, soil-transmitted helminth infection and handwashing behaviour, in low and middle income country settings.

RESULTS: Eight studies were included in this review: seven cluster-randomised controlled trials and one cluster non-randomised controlled trial. All eight studies targeted children aged 5-12 attending primary school but were heterogeneous for both the type of intervention and the reported outcomes so results were synthesised qualitatively. None of the studies were of high quality and the large majority were at high risk of bias. The reported effect of child-targeted handwashing interventions on our outcomes of interest varied between studies. Of the different interventions reported, no one approach to promoting handwashing among children appeared most effective.

CONCLUSION: Our review found very few studies that evaluated handwashing interventions targeting children and all had various methodological limitations. It is plausible that interventions which succeed in changing children’s handwashing practices will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group. The current paucity of evidence in this area however does not permit any recommendations to be made as to the most effective route to increasing handwashing with soap practice among children in LMIC. This article is protected by copyright. All rights reserved.

2 – Am J Infect Control. 2017 Feb 24. pii: S0196-6553(17)30041-X. doi: 10.1016/j.ajic.2017.01.018. [Epub ahead of print]

The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review.

BACKGROUND: Hand-hygiene interventions are widely used in schools but their effect on reducing absenteeism is not well known.

RESULTS: Our review indicated evidence is available to show hand-hygiene interventions had an effect on reducing acute gastrointestinal illness-associated absenteeism but inadequate evidence is available to show an effect on respiratory illness-associated absenteeism.

CONCLUSIONS: The methodologic quality assessment of eligible studies revealed common design flaws, such as lack of randomization, blinding, and attrition, which must be addressed in future studies to strengthen the evidence base on the effect of hand-hygiene interventions on school absenteeism.

15 October was Global Handwashing Day: take the quiz!

Photo: IRC

Are you a Handwashing Champion?

Each year on 15 October, over 200 million people in over 100 countries celebrate Global Handwashing Day. Their aim is to increase awareness and understanding about the importance of handwashing with soap. This simple intervention is an effective and affordable way to prevent diseases and save lives. Promoting handwashing with soap reduces the risk of diarrhoea by at least 23% according to a 2014 systematic review of research. Handwashing with soap impacts more than just health: it is also beneficial for nutrition, education, economics, and equity.

Global Handwashing Day was founded by the Global Public-Private Partnership for Handwashing, and is an opportunity to design, test, and replicate creative ways to encourage people to wash their hands with soap at critical times. This year’s theme is “Make Handwashing a Habit!” For handwashing to be effective it must be practised consistently at key times, such as after using the toilet or before contact with food. While habits must be developed over time, this theme emphasises the importance of handwashing as a ritual behaviour for long-term sustainability.

IRC is proud to be an affiliate member of the Global Public-Private Partnership for Handwashing. Especially for Global Handwashing Day we created a fun quiz so that you can not only test your knowledge but also learn a bit about what we are doing to promote handwashing.

Don’t forget to visit the Global Handwashing Day website for resources and updates on  global handwashing promotion. For the latest research and developments, also check out the handwashing posts on Sanitation Updates.

Now take the quiz to see if you are a Handwashing Champion!

This blog was originally posted on the IRC website.

 

USAID – Celebrate Global Handwashing Day 2016!

USAID – Celebrate Global Handwashing Day 2016!

On Global Handwashing Day, we join partners around the world to celebrate the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives. Handwashing is an important part of the U.S. Agency for International Development’s (USAID’s) efforts to end preventable child and maternal deaths. 

Although many people around the world clean their hands with water, the use of soap is also necessary to prevent disease more effectively.

• Millions of children under the age of 5 years die from diarrheal diseases and pneumonia. Handwashing with soap could prevent about 1 out of every 3 episodes of diarrheal illnesses and almost 1 out of 6 episodes of respiratory infections like pneumonia.
• Handwashing with soap is also a key component of clean and safe birthing practices, which could save up to 40 percent of the 2.8 million infants that die during their first month of life.

USAID’s life-saving water, sanitation and hygiene (WASH) programs and other development activities promote adoption of handwashing and other hygiene practices as an important element of improved health and nutrition programs.

Learn more

• See how the Povu Poa is increasing handwashing in Kenya
• Listen to Robert Dreibelbis on Handwashing Behavior Change in Bangladesh
• Learn more about USAID’s work in water, sanitation, and hygiene
• Learn more about USAID’s maternal and child health efforts
• Read about USAID’s flagship Maternal and Child Survival Program’s work to achieve clean clinics in Haiti

Photo credit: USAID

Handwashing/hygiene research by the SHARE Project

Below are links to selected studies, videos, etc. by the SHARE project. 

Hygiene Promotion Resource: Choose Soap – The RIU Summary provides an overview of the objectives and intended RIU impact of the SHARE-commissioned Choose Soap toolkit.

Complementary Food Hygiene – An Overlooked Opportunity in the WASH, Nutrition and Health Sectors – This policy brief highlights the often overlooked opportunity that addressing complementary food hygiene offers the WASH, nutrition and health sectors for improving health outcomes.

The Impact of Water, Sanitation and Hygiene on Key Health and Social Outcomes: Review of Evidence – This evidence paper developed by SHARE and UNICEF looks at 10 areas identified collaboratively on which WASH can plausibly have a strong impact: diarrhoea, nutrition, complementary food hygiene, female psychosocial stress, violence, maternal and newborn health, menstrual hygiene management, school attendance, oral vaccine performance, and neglected tropical diseases.

Hygiene Intervention Reduces Contamination of Weaning Food in Bangladesh – This journal paper summarises the findings of a small, SHARE-funded intervention study that sought to reduce the contamination of weaning foods in Bangladesh by using the HACCP approach.

Focus on Handwashing in Emergency Settings – This event report summarises the proceedings of the ‘Focus on Handwashing in Emergency Settings’ event held at LSHTM on 19th December 2012.

Handwashing With Soap Guidelines – This four-page guidance note, produced by SHARE and LSHTM, explains the benefits of handwashing with soap, highlights when it has the most significant public health impact, and provides tips on how to encourage the practice.

Estimating the Potential Impact of Sanitary Child Stool Disposal – This policy brief highlights the often overlooked and enormous potential of hygienic child stool disposal to considerably reduce the prevalence of diarrhoeal diseases.

Effect of a Behaviour Change Intervention on Handwashing with Soap in India (SuperAmma): A Cluster Randomised Trial – This paper summarises the findings of a cluster randomised trial that tested whether a scalable village-level intervention based on emotional drivers of behaviour, rather than knowledge, could improve handwashing behaviour in rural India.

What Drives Handwashing Behaviour? – In this video, Dr Valerie Curtis, Director of the Hygiene Centre at LSHTM, discusses what drives us to wash our hands with soap.

Handwashing in the news

Oct 13 – Hilton Launches Major Expansion of Industry’s Largest Soap Recycling Program to Help Communities in Need – -Hilton announced that all 750 properties across its All Suites brands will recycle discarded soap and amenity bottles and donate them to reduce hygiene-related illnesses for communities in need

Oct 12 – Students can Become ‘Hand Washing Champions’ in Celebration of Global Handwashing Day on October 15th – Each year on October 15th, over 200 million people in over 100 countries take part in celebrations to mark Global Handwashing Day. Once again, Deb Group is heavily involved in this day of advocacy.

Oct 11 – Dettol aims to educate millions across 19 countries on Global Handwashing Day  – As a part of the Global Handwashing Day celebrations, Dettol has launched a global campaign which aims to reach out to millions of people across 19 countries and educate them about importance of handwashing.

Oct 10 – WaterAid: Global Handwashing Day – It’s time to talk about the world’s simplest life-saver.

Oct 7 – Habits matter for Global Handwashing Day. This is why you should promote them! – Celebrated annually on October 15, Global Handwashing Day is a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an easy, effective, and affordable way to prevent diseases and save lives. This year’s theme is “Make Handwashing a Habit!”. In light of this theme, I would like to take this opportunity to discuss how promoting habits as part of your celebration might lead to the development of sustained handwashing behavior.