Serial Measurements of Soap Weights and Soap Availability to Describe Handwashing Behavior

Meghana A. Gadgil Center for Innovation in Global Health, Stanford University, Stanford, California;
School of Public Health and Health Professions, University at Buffalo, Buffalo, New York;

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Yushuf Sharker International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh

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Leanne Unicomb International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh

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Pavani K. Ram School of Public Health and Health Professions, University at Buffalo, Buffalo, New York;

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Stephen P. Luby Center for Innovation in Global Health, Stanford University, Stanford, California;
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh

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Available measures of handwashing are prone to bias. We tested the feasibility and reliability of weighing soap at repeated visits and subtracting the measured weight from the prior weight to assess daily per capita soap consumption in a low-income community in Dhaka, Bangladesh. Fieldworkers approached 220 households twice weekly over 2 months. They interviewed participants, weighed soap, and assessed hand cleanliness and the presence of a handwashing station. Respondents used bar soap (91% [201]) and laundry detergent cakes (39% [85]) for handwashing as well as for bathing and laundry. Ninety-eight percent of households had bar soap present on at least one visit, although only 50% had bar soap at every visit during the 2-month period. Fieldworkers observed a soap fragment on the wall near the latrine in 27% (470) of visits. Households consumed a mean 1.5 g of bar soap and 3.2 g detergent cake per person per day. Daily per capita soap consumption was similar in households visited by fieldworkers after different intervals (2, 3, 4, or 5 days). Soap consumption was not associated with household wealth, education of the household head, the presence of a handwashing station, the presence of water or soap at a handwashing station, or palm inspections of the mother or child. Soap weight measurements were an objective, reliable measure of soap consumption that provided different information from other handwashing indicators. The frequent use of a soap product for purposes other than handwashing complicates using soap consumption as a handwashing measure.

Author Notes

Address correspondence to Stephen P. Luby, Stanford University, Y2E2, MC 4205, 473 Via Ortega, Stanford, CA 94305. E-mail: sluby@stanford.edu

Financial support: This study was financially supported by the U.S. Centers for Disease Control, the U.S. State Department, Fulbright Scholar Program, and the Stanford University Center for Innovation in Global Health. The conclusions are the authors’ own and should not be construed as official position of the U.S. Government.

Disclosure: S. P. L. has provided consultation to Procter & Gamble, a multinational soap manufacturer, within the last 5 years.

Authors’ addresses: Meghana A. Gadgil, Dell Medical School, University at Texas at Austin, Austin, TX, E-mail: meghana.gadgil@austin.utexas.edu. Yushuf Sharker, Yale School of Medicine, Haven, CT, E-mail: yushuf.sharker@yale.edu. Leanne Unicomb, International Center for Diarrheal Disease Research, Dhaka, Bangladesh, E-mail: leanne@icddrb.org. Pavani K. Ram, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, E-mail: pkram@buffalo.edu. Stephen P. Luby, Center for Innovation in Global Health, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu.

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