Volume 95, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



This study explored the steps of food preparation, related handwashing opportunities, current practices, and community perceptions regarding foods at high-risk of contamination such as mashed foods and salads. In three rural Bangladeshi villages, we collected qualitative and observational data. Food preparation was a complex and multistep process. Food preparation was interrupted by tasks that could contaminate the preparers' hands, after which they continued food preparation without washing hands. Community members typically ate hand-mixed, uncooked mashed food and salad as accompaniments to curry and rice at meals. Hand-mixed dried foods were mostly consumed as a snack. Observers recorded handwashing during preparation of these foods. Among 24 observed caregivers, of 85 opportunities to wash hands with soap during food preparation, washing hands with soap occurred twice, both times after cutting fish, whereas washing hands with water alone was common. A simple and feasible approach is promotion of handwashing with soap upon entering and re-entering the food preparation area, and ensuring that everything needed for handwashing should be within easy reach.


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  1. National Institute of Population Research and Training (NIPORT), 2013. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh: NIPORT and Mitra and Associates and Calverton, MD: MEASURE DHS, ICF International.
  2. Liu L, Li Q, Lee RA, Friberg IK, Perin J, Walker N, Black RE, , 2011. Trends in causes of death among children under 5 in Bangladesh, 1993–2004: an exercise applying a standardized computer algorithm to assign causes of death using verbal autopsy data. Popul Health Metr 9: 43.[Crossref]
  3. Kaferstein F, , 2003. Foodborne diseases in developing countries: aetiology, epidemiology and strategies for prevention. Int J Environ Health Res 13 (Suppl 1): S161S168.[Crossref]
  4. Esrey SA, Feachem RG, Hughes JM, , 1985. Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities. Bull World Health Organ 63: 757772.
  5. Esrey SA, , 1990. Food contamination and diarrhoea. World Health January–February: 1923.
  6. Motarjemi Y, Kaferstein F, Moy G, Quevedo F, , 1993. Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition. Bull World Health Organ 71: 7992.
  7. Curtis V, Cairncross S, , 2003. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 3: 275281.[Crossref]
  8. Curtis V, Biran A, Deverell K, Hughes C, Bellamy K, Drasar B, , 2003. Hygiene in the home: relating bugs and behaviour. Soc Sci Med 57: 657672.[Crossref]
  9. Ehiri JE, Azubuike MC, Ubbaonu CN, Anyanwu EC, Ibe KM, Ogbonna MO, , 2001. Critical control points of complementary food preparation and handling in eastern Nigeria. Bull World Health Organ 79: 423433.
  10. Devamani C, Norman G, Schmidt WP, , 2014. A simple microbiological tool to evaluate the effect of environmental health interventions on hand contamination. Int J Environ Res Public Health 11: 1184611859.[Crossref]
  11. Agustina R, Sari TP, Satroamidjojo S, Bovee-Oudenhoven IM, Feskens EJ, Kok FJ, , 2013. Association of food-hygiene practices and diarrhea prevalence among Indonesian young children from low socioeconomic urban areas. BMC Public Health 13: 977.[Crossref]
  12. Lynch MF, Tauxe RV, Hedberg CW, , 2009. The growing burden of foodborne outbreaks due to contaminated fresh produce: risks and opportunities. Epidemiol Infect 137: 307315.[Crossref]
  13. Sivapalasingam S, Friedman CR, Cohen L, Tauxe RV, , 2004. Fresh produce: a growing cause of outbreaks of foodborne illness in the United States, 1973 through 1997. J Food Prot 67: 23422353.[Crossref]
  14. Islam MS, Hasan MK, Khan SI, , 1993. Growth and survival of Shigella flexneri in common Bangladeshi foods under various conditions of time and temperature. Appl Environ Microbiol 59: 652654.
  15. Kolvin JL, Roberts D, , 1982. Studies on the growth of Vibrio cholerae biotype eltor and biotype classical in foods. J Hyg (Lond) 89: 243252.[Crossref]
  16. Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB, , 2011. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 8: e1001052.[Crossref]
  17. Monte CM, Ashworth A, Nations MK, Lima AA, Barreto A, Huttly SR, , 1997. Designing educational messages to improve weaning food hygiene practices of families living in poverty. Soc Sci Med 44: 14531464.[Crossref]
  18. Stone VE, Hogan JW, Schuman P, Rompalo AM, Howard AA, Korkontzelou C, Smith DK, Hers S, , 2001. Antiretroviral regimen complexity, self-reported adherence, and HIV patients' understanding of their regimens: survey of women in the her study. J Acquir Immune Defic Syndr 28: 124131.[Crossref]
  19. Martin S, Wolters PL, Calabrese SK, Toledo-Tamula MA, Wood LV, Roby G, Elliott-DeSorbo DK, , 2007. The Antiretroviral Regimen Complexity Index. A novel method of quantifying regimen complexity. J Acquir Immune Defic Syndr 45: 535544.[Crossref]
  20. Mata J, Todd PM, Lippke S, , 2010. When weight management lasts. Lower perceived rule complexity increases adherence. Appetite 54: 3743.[Crossref]
  21. Rogers EM, , 2003. Diffusion of Innovations, 5th edition. New York, NY: Free Press, 16.
  22. Biran A, Schmidt WP, Varadharajan KS, Rajaraman D, Kumar R, Greenland K, Gopalan B, Aunger R, Curtis V, , 2014. Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial. Lancet Glob Health 2: e145e154.[Crossref]
  23. Toure O, Coulibaly S, Arby A, Maiga F, Cairncross S, , 2013. Piloting an intervention to improve microbiological food safety in peri-urban Mali. Int J Hyg Environ Health 216: 138145.[Crossref]
  24. Tumwine J, Katui-Katua M, Munguti K, , 2002. Drawers of Water. II: 30 Years of Change in Domestic Use and Environmental Health in East Africa. London, United Kingdom: International Institute for Environment and Development.
  25. Henry FJ, Patwary Y, Huttly SR, Aziz KM, , 1990. Bacterial contamination of weaning foods and drinking water in rural Bangladesh. Epidemiol Infect 104: 7985.[Crossref]
  26. Mack TM, , 2001. The new pan-Asian paan problem. Lancet 357: 16381639.[Crossref]
  27. Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP, , 2013. The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health 13: 1015.[Crossref]
  28. Sheth M, Patel J, Sharma S, Seshadri S, , 2000. Hazard analysis and critical control points of weaning foods. Indian J Pediatr 67: 405410.[Crossref]
  29. Khan M, Shahidullah M, , 1980. Contrasting epidemiology of shigellae dysenteriae and shigellae flexneri, Dacca. Trans R Soc Trop Med Hyg 74: 528533.[Crossref]
  30. Nizame FA, Unicomb L, Sanghvi T, Roy S, Nuruzzaman M, Ghosh PK, Winch PJ, Luby SP, , 2013. Handwashing before food preparation and child feeding: a missed opportunity for hygiene promotion. Am J Trop Med Hyg 89: 11791185.[Crossref]
  31. Nizame FA, Nasreen S, Halder AK, Arman S, Winch PJ, Unicomb L, Luby SP, , 2015. Observed practices and perceived advantages of different hand cleansing agents in rural Bangladesh: ash, soil, and soap. Am J Trop Med Hyg 92: 11111116.[Crossref]
  32. Curtis VA, Danquah LO, Aunger RV, , 2009. Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res 24: 655673.[Crossref]
  33. Whitby M, Pessoa-Silva CL, McLaws ML, Allegranzi B, Sax H, Larson E, Seto WH, Donaldson L, Pittet D, , 2007. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 65: 18.[Crossref]
  34. Halder AK, Tronchet C, Akhter S, Bhuiya A, Johnston R, Luby SP, , 2010. Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh. BMC Public Health 10: 545.[Crossref]
  35. Rabbi SE, Dey NC, , 2013. Exploring the gap between hand washing knowledge and practices in Bangladesh: a cross-sectional comparative study. BMC Public Health 13: 89.[Crossref]
  36. Centers for Disease Control and Prevention (CDC), 2014. Wash Your Hands. Available at: http://www.cdc.gov/features/handwashing. Accessed November 24, 2014.
  37. Strohbehn C, Sneed J, Paez P, Meyer J, , 2008. Hand washing frequencies and procedures used in retail food services. J Food Prot 71: 16411650.[Crossref]
  38. Young KD, Aarde RJV, , 2011. Science and elephant management decisions in South Africa. Biol Conserv 144: 876885.[Crossref]
  39. Surujlal M, Badrie N, , 2004. Household consumer food safety in Trinidad, West Indies. Internet J Food Saf 3: 814.
  40. Gorman R, Bloomfield S, Adley CC, , 2002. A study of cross-contamination of food-borne pathogens in the domestic kitchen in the Republic of Ireland. Int J Food Microbiol 76: 143150.[Crossref]
  41. Rangel JM, Sparling PH, Crowe C, Griffin PM, Swerdlow DL, , 2005. Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982–2002. Emerg Infect Dis 11: 603609.[Crossref]
  42. Ryan MJ, Wall PG, Gilbert RJ, Griffin M, Rowe B, , 1996. Risk factors for outbreaks of infectious intestinal disease linked to domestic catering. Commun Dis Rep CDR Rev 6: R179R183.
  43. Luby SP, Halder AK, Tronchet C, Akhter S, Bhuiya A, Johnston RB, , 2009. Household characteristics associated with handwashing with soap in rural Bangladesh. Am J Trop Med Hyg 81: 882887.[Crossref]
  44. Hulland KR, Leontsini E, Dreibelbis R, Unicomb L, Afroz A, Dutta NC, Nizame FA, Luby SP, Ram PK, Winch PJ, , 2013. Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health 13: 877.[Crossref]
  45. UNICEF, 2015. Hygiene Practices Have Helped Keep Ebola Out of the Classroom. Available at: http://www.unicef.org/media/media_82875.html. Accessed February 13, 2016.
  46. Ilesanmi OS, Alele FO, , 2015. The effect of Ebola virus disease outbreak on hand washing among secondary school students in Ondo State Nigeria, October, 2014. Pan Afr Med J 22 (Suppl 1): 24.
  47. Cousens S, Kanki B, Toure S, Diallo I, Curtis V, , 1996. Reactivity and repeatability of hygiene behaviour: structured observations from Burkina Faso. Soc Sci Med 43: 12991308.[Crossref]
  48. Ram PK, Halder AK, Granger SP, Jones T, Hall P, Hitchcock D, Wright R, Nygren B, Islam MS, Molyneaux JW, Luby SP, , 2010. Is structured observation a valid technique to measure handwashing behavior? Use of acceleration sensors embedded in soap to assess reactivity to structured observation. Am J Trop Med Hyg 83: 10701076.[Crossref]
  49. Touré O, Coulibaly S, Arby A, Maiga F, Cairncross S, , 2011. Improving microbiological food safety in peri-urban Mali: an experimental study. Food Contr 22: 15651572.[Crossref]
  50. Weinstein ND, Rothman AJ, Sutton SR, , 1998. Stage theories of health behavior: conceptual and methodological issues. Health Psychol 17: 290299.[Crossref]
  51. Leontsini E, Rosenbaum J, Báez C, Solís A, Valera C, Gonzálvez G, , 2004. NEgociación de PRÁcticas Mejoradas—NEPRÁM (Negotiation of Improved Practices): the development of a national behaviour change strategy for community-based prevention of dengue fever in the Dominican Republic. Dengue Bull 28 (Suppl): 2225.
  52. Harvey SA, Paredes Olortegui M, Leontsini E, Ramal Asayag C, Scott K, Winch PJ, , 2013. Trials of improved practices (TIPs): a strategy for making long-lasting nets last longer? Am J Trop Med Hyg 88: 11091115.[Crossref]
  53. Story M, Neumark-Sztainer D, French S, , 2002. Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc 102: S40S51.[Crossref]
  54. Gielen AC, Sleet D, , 2003. Application of behavior-change theories and methods to injury prevention. Epidemiol Rev 25: 6576.[Crossref]
  55. Amin N, Pickering AJ, Ram PK, Unicomb L, Najnin N, Homaira N, Ashraf S, Abedin J, Islam MS, Luby SP, , 2014. Microbiological evaluation of the efficacy of soapy water to clean hands: a randomized, non-inferiority field trial. Am J Trop Med Hyg 91: 415423.[Crossref]
  56. Saboori S, Mwaki A, Rheingans R, , 2010. Is soapy water a viable solution for handwashing in schools? Waterlines 29: 329336.[Crossref]
  57. Green LW, , 2005. Health Program Planning: An Educational and Ecological Approach, 4th edition. New York, NY: McGraw-Hill.

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  • Received : 20 May 2015
  • Accepted : 14 Apr 2016

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