Using Child Health Outcomes to Identify Effective Measures of Handwashing

Stephen P. Luby Infectious Diseases and Vaccine Sciences, ICDDR,B, Dhaka, Bangladesh; Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland

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Amal K. Halder Infectious Diseases and Vaccine Sciences, ICDDR,B, Dhaka, Bangladesh; Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland

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Tarique M. N. Huda Infectious Diseases and Vaccine Sciences, ICDDR,B, Dhaka, Bangladesh; Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland

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Leanne Unicomb Infectious Diseases and Vaccine Sciences, ICDDR,B, Dhaka, Bangladesh; Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland

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Richard B. Johnston Infectious Diseases and Vaccine Sciences, ICDDR,B, Dhaka, Bangladesh; Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland

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We assessed which practical handwashing indicators were independently associated with reduced child diarrhea or respiratory disease. Fieldworkers collected 33 indicators of handwashing at baseline in 498 households in 50 villages in rural Bangladesh. Community monitors visited households monthly and asked standard questions about diarrhea and symptoms of respiratory illness among children under 5 years of age. In multivariate analysis, three handwashing indicators were independently associated with less child diarrhea—mothers reporting usually washing hands with soap before feeding a child, mothers using soap when asked to show how they usually washed their hands after defecation, and children having visibly clean finger pads. Two indicators were independently associated with fewer respiratory infections—mothers allowing their hands to air dry after the handwashing demonstration and the presence of water where the respondents usually wash hands after defecation. These rapid handwashing indicators should be considered for inclusion in handwashing assessments.

Author Notes

*Address correspondence to Stephen P. Luby, Infectious Diseases and Vaccine Sciences, ICDDR,B, GPO Box 128, Dhaka-1000, Bangladesh. E-mail: sluby@icddrb.org

Authors' addresses: Stephen P. Luby, Amal K. Halder, Tarique M. N. Huda, and Leanne Unicomb, Infectious Diseases and Vaccine Sciences, ICDDR,B, Dhaka, Bangladesh, E-mails: sluby@icddrb.org, amalk@icddrb.org, tariqueh@icddrb.org, and leanne@icddrb.org. Richard B. Johnston, Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland, E-mail: richard.johnston@eawag.ch.

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