Handwashing before Food Preparation and Child Feeding: A Missed Opportunity for Hygiene Promotion

Fosiul A. Nizame International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Leanne Unicomb International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Tina Sanghvi International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Sumitro Roy International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Md. Nuruzzaman International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Probir K. Ghosh International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Peter J. Winch International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Stephen P. Luby International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Alive and Thrive, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Enteric diseases are often caused by poor hygiene and can contribute to stunting. From 50 randomly selected villages in Bangladesh, we collected quantitative and qualitative data on handwashing linked to child feeding to integrate handwashing promotion into a young child complementary feeding program. Most participants stated that the community knew the importance of handwashing with soap before food preparation and feeding a child, but had not developed the habit. We observed no handwashing with soap at these key times; sometimes hands were rinsed with water only. Most participants cited the unavailability of soap and water near the cooking place as a barrier to handwashing before food preparation. Most caregivers ranked nurturing messages as the best motivator to encourage handwashing with soap. An integrated intervention should include having soap and water available near the food preparation area and should use nurturing themes to encourage habitual handwashing with soap.

Author Notes

* Address correspondence to Fosiul A. Nizame, WATSAN Research Group, Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh. E-mail: fosiul@icddrb.org

Financial support: This study was supported by the Gates Foundation through Alive and Thrive.

Authors' addresses: Fosiul A. Nizame, Leanne Unicomb, Muhammad Nuruzzaman, and Probir K. Ghosh, WATSAN Research Group, Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh, E-mails: fosiul@icddrb.org, leanne@icddrb.org, nuruzzaman@icddrb.org, and probir@icddrb.org. Tina Sanghvi and Sumitro Roy, Alive and Thrive Program/Family Health International, Dhaka, Bangladesh, E-mails: tsanghvi@fhi360.org and suroy@fhi360.org. Peter J. Winch, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: pwinch@jhsph.edu. Stephen P. Luby, Woods Institute of the Environment, Stanford University, Yang and Yamazaki Environment and Energy Building, Stanford, CA, E-mail: sluby@stanford.edu.

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