Observed Practices and Perceived Advantages of Different Hand Cleansing Agents in Rural Bangladesh: Ash, Soil, and Soap

Fosiul A. Nizame icddr,b, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Stanford University, Stanford, California

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Sharifa Nasreen icddr,b, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Stanford University, Stanford, California

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Amal K. Halder icddr,b, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Stanford University, Stanford, California

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Shaila Arman icddr,b, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Stanford University, Stanford, California

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Peter J. Winch icddr,b, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Stanford University, Stanford, California

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Leanne Unicomb icddr,b, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Stanford University, Stanford, California

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Stephen P. Luby icddr,b, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Stanford University, Stanford, California

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Bangladeshi communities have historically used ash and soil as handwashing agents. A structured observation study and qualitative interviews on the use of ash/soil and soap as handwashing agents were conducted in rural Bangladesh to help develop a handwashing promotion intervention. The observations were conducted among 1,000 randomly selected households from 36 districts. Fieldworkers observed people using ash/soil to wash their hand(s) on 13% of occasions after defecation and on 10% after cleaning a child's anus. This compares with 19% of people who used soap after defecation and 27% after cleaning a child who defecated. Using ash/soil or soap was rarely (< 1%) observed at other times recommended for handwashing. The qualitative study enrolled 24 households from three observation villages, where high usage of ash/soil for handwashing was detected. Most informants reported that ash/soil was used only for handwashing after fecal contact, and that ash/soil could clean hands as effectively as soap.

Author Notes

* Address correspondence to Fosiul A. Nizame, Moyeen Centre, House 9b, Road 3, Gulsha 1, Dhaka 1212, Bangladesh. E-mails: fosiul@icddrb.org or fosiul05@gmail.com

Financial support: The structured observation study protocol was funded by United Kingdom Department for International Development (DFID) through UNICEF Bangladesh, and the qualitative investigation protocol was funded by the US Agency for International Development (USAID).

Authors' addresses: Fosiul A. Nizame, Amal K. Halder, and Leanne Unicomb, Water, Sanitation and Hygiene (WASH) Research Group, Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh, E-mails: fosiul@icddrb.org, amalk@icddrb.org, and leanne@icddrb.org. Sharifa Nasreen, Gainesville, FL, E-mail: drsharifa74@gmail.com. Shaila Arman, Toronto, Canada, E-mail: shailaarman@icddrb.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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