1921
Volume 97, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

In 2009, a common set of questions addressing handwashing behavior was introduced into nationally representative Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), providing large amounts of comparable data from numerous countries worldwide. The objective of this analysis is to describe global handwashing patterns using two proxy indicators for handwashing behavior from 51 DHS and MICS surveys conducted in 2010–2013: availability of soap anywhere in the dwelling and access to a handwashing place with soap and water. Data were also examined across geographic regions, wealth quintiles, and rural versus urban settings. We found large disparities for both indicators across regions, and even among countries within the same World Health Organization region. Within countries, households in lower wealth quintiles and in rural areas were less likely to have soap anywhere in the dwelling and at designated handwashing locations than households in higher wealth quintiles and urban areas. In addition, disparities existed among various geographic regions within countries. This analysis demonstrates the need to promote access to handwashing materials and placement at handwashing locations in the dwelling, particularly in poorer, rural areas where children are more vulnerable to handwashing-preventable syndromes such as pneumonia and diarrhea.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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2017-08-23
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References

  1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE, , 2015. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385: 430440.[Crossref]
  2. United Nations Children’s Fund, 2013. Committing to Child Survival: A Promise Renewed. New York, NY: United Nations Children’s Fund.
  3. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O’Brien KL, Campbell H, Black RE, , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.[Crossref]
  4. Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, Molbak K, Valentiner-Branth P, Lanata CF, Black RE, , 2008. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol 37: 816830.[Crossref]
  5. Lorntz B, Soares A, Moore S, Pinkerton R, Gansneder B, Bovbjerg V, Guyatt H, Lima A, Guerrant R, , 2006. Early childhood diarrhea predicts impaired school performance. Pediatr Infect Dis J 25: 513520.[Crossref]
  6. Patrick PD, Oria RB, Madhavan V, Pinkerton RC, Lorntz B, Lima AA, Guerrant RL, , 2005. Limitations in verbal fluency following heavy burdens of early childhood diarrhea in Brazilian shantytown children. Child Neuropsychol 11: 233244.[Crossref]
  7. Lin A, Arnold BF, Afreen S, Goto R, Huda TMN, Haque R, Raqib R, Unicomb L, Ahmed T, Colford JM, , 2013. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 89: 130137.[Crossref]
  8. 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]
  9. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA, , 2008. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev CD004265.
  10. Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM, , 2005. Effect of handwashing on child health: a randomised controlled trial. Lancet 366: 225233.[Crossref]
  11. Aiello AE, Coulborn RM, Perez V, Larson EL, , 2008. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health 98: 13721381.[Crossref]
  12. Cairncross S, Valdmanis V, , 2006. Water supply, sanitation, and hygiene promotion, 2nd edition. Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, eds. Disease Control Priorities in Developing Countries. Washington, DC: World Bank.
  13. Curtis VA, Danquah LO, Aunger RV, , 2009. Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res 24: 655673.[Crossref]
  14. Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JP, Wolf J, Pruss-Ustun A, Bonjour S, Hunter PR, Fewtrell L, Curtis V, , 2014. Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Health 19: 906916.[Crossref]
  15. Loughnan L, , 2013. Hand Washing with Soap: 1986–2009 Data from the MICS, DHS and WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP). Chapel Hill, NC: UNC Water and Health.
  16. United Nations Children’s Fund, 2017. MICS6 Questionnaires and Modules. New York, NY: UNICEF.
  17. U.S. Agency for International Development, 2015. Model Questionnaires DHS, Measure DHS. Available at: http://www.dhsprogram.com/publications/publication-dhsq7-dhs-questionnaires-and-manuals.cfm. Accessed July 7, 2017.
  18. Loughnan LC, Ram PK, Luyendijk R, , 2015. Measurement of handwashing behaviour in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 1985–2008. Waterlines 34: 296313.
  19. Biran A, Rabie T, Schmidt W, Juvekar S, Hirve S, Curtis V, , 2008. Comparing the performance of indicators of hand-washing practices in rural Indian households. Trop Med Int Health 13: 278285.[Crossref]
  20. Danquah L, , 2010. Measuring hand washing behaviour: methodological and validity issues. Dhaka, Bangladesh: South Asia Hygiene Practitioners’ Workshop.
  21. Manun’Ebo M, Cousens S, Haggerty P, Kalengaie M, Ashworth A, Kirkwood B, , 1997. Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire. Trop Med Int Health 2: 10151021.[Crossref]
  22. Stanton BF, Clemens JD, Aziz KM, Rahman M, , 1987. Twenty-four-hour recall, knowledge-attitude-practice questionnaires, and direct observations of sanitary practices: a comparative study. Bull World Health Organ 65: 217222.
  23. Ram P, , 2013. Practical Guidance for Measuring Handwashing Behavior: 2013 Update. Washington, DC: Water and Sanitation Program.
  24. Ram PK, Sahli M, Arnold B, Colford JM, Jr Chase C, Briceno B, Orsola-Vidal A, Gertler PJ, , 2014. Validity of Rapid Measures of Handwashing Behavior; An analysis of data from Multiple Impact Evaluations in the Global Scaling Up Handwashing Project. Washington, DC: Water and Sanitation Program/The World Bank.
  25. 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]
  26. Luby SP, Halder AK, Huda TM, Unicomb L, Johnston RB, , 2011. Using child health outcomes to identify effective measures of handwashing. Am J Trop Med Hyg 85: 882892.[Crossref]
  27. Luby SP, Halder AK, , 2008. Associations among handwashing indicators, wealth, and symptoms of childhood respiratory illness in urban Bangladesh. Trop Med Int Health 13: 835844.[Crossref]
  28. 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]
  29. The DHS Program, 2017. Wealth Index Construction . Available at: http://www.dhsprogram.com/topics/wealth-index/Wealth-Index-Construction.cfm. Accessed January 1, 2017.
  30. UN Inter-agency Group for Child Mortality Estimation, 2015. Levels and Trends in Child Mortality: Report 2015. New York, NY: United Nations Children’s Fund.
  31. Houweling TA, Kunst AE, , 2010. Socio-economic inequalities in childhood mortality in low- and middle-income countries: a review of the international evidence. Br Med Bull 93: 726.[Crossref]
  32. Hoque BA, Mahalanabis D, Alam MJ, Islam MS, , 1995. Post-defecation handwashing in Bangladesh: practice and efficiency perspectives. Public Health 109: 1524.[Crossref]
  33. 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]
  34. Saboori S, Mwaki A, Porter S, Okech B, Freeman M, Rheingans R, , 2010. Is soapy water a viable solution for handwashing in schools? Waterlines 29: 329336.[Crossref]
  35. Curtis VA, Garbrah-Aidoo N, Scott B, , 2007. Ethics in public health research: masters of marketing: bringing private sector skills to public health partnerships. Am J Public Health 97: 634641.[Crossref]
  36. Rajaraman D, Varadharajan KS, Greenland K, Curtis V, Kumar R, Schmidt WP, Aunger R, Biran A, , 2014. Implementing effective hygiene promotion: lessons from the process evaluation of an intervention to promote handwashing with soap in rural India. BMC Public Health 14: 1179.[Crossref]
  37. Curtis V, Kanki B, Cousens S, Diallo I, Kpozehouen A, Sangare M, Nikiema M, , 2001. Evidence of behavior change following a hygiene promotion programme in Burkina Faso. Bull World Health Organ 79: 518527.
  38. Parveen S, Nasreen S, Vujcic J, Kamm KB, Akhter S, Akter S, Khan S, Lopa TM, Luby SP, Ram PK, , 2011. Barriers and Motivators for Handwashing among Mothers of Neonates in Rural Bangladesh. Philadelphia, PA: American Society of Tropical Medicine and Hygiene.
  39. Arnold BF, , 2013. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open 3: e003476.[Crossref]
  40. Kamm KB, Feikin DR, Bigogo G, Aol G, Audi A, Cohen AL, Shah M, Yu J, Breiman RF, Ram PK, , 2014. Associations between presence of handwashing stations and soap in the home and diarrhoea and respiratory illness, in children less than five years old in rural western Kenya. Trop Med Int Health 19: 398406.[Crossref]
  41. Yudhoyono SB, Sirleaf EJ, , Cameron D, 2013. A New Global Partnership: Eradicate Poverty and Transform Economies Through Sustainable Development. New York, NY: United Nations.
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Supplementary Data

Supplemental Table

  • Received : 06 Jun 2016
  • Accepted : 17 Mar 2017

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