1921
Volume 99, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Handwashing with soap at key times is an effective means of reducing pathogen transmission. In a low-income community in urban Dhaka, we piloted and evaluated the acceptability and feasibility of a shared handwashing intervention. This included promotion by community health promoters of a homemade solution of detergent powder mixed with water and stored in a 1.5-L reclaimed mineral water bottle. Community health promoters encouraged sharing of the recurrent detergent cost among compound members. Of 152 participating compounds, fieldworkers randomly selected 60 for qualitative assessment. Fieldworkers conducted 30 in-depth interviews and five focus group discussions among purposively selected compound members. The reclaimed bottles served as an easily accessible dispenser for the soapy water, which could feasibly be retained next to the toilet and kitchen areas for communal use. Bottles functioned as a positive reminder for handwashing at recommended key times. Most compounds (45/60, 75%) shared a common soapy water system and its associated costs. There was reluctance to prepare soapy water for shared use in the remaining 25%. Soapy water was an acceptable hand cleaning agent, with the bottle as a feasible dispenser. It was simple in design, cost-effective, replicable, popular with intervention recipient, and neighboring nonrecipients, and commonly shared among nonrelated households. The need to share expenses and product preparation served as a barrier. Developing a sustainable maintenance system, therefore, is critical to ensuring the public health benefits of handwashing with soap.

[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.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.17-0672
2018-08-02
2018-08-20
Loading full text...

Full text loading...

/deliver/fulltext/14761645/99/2/tpmd170672.html?itemId=/content/journals/10.4269/ajtmh.17-0672&mimeType=html&fmt=ahah

References

  1. Steel N, , 2016. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 15451602.
  2. Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A, , 2011. Hygiene: new hopes, new horizons. Lancet Infect Dis 11: 312321.
  3. 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.
  4. 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.
  5. Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB, , 2011. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 8: e1001052.
  6. Curtis V, Danquah LO, Aunger RV, , 2009. Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res 24: 655673.
  7. Freeman MC, 2014. Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Health 19: 906916.
  8. 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.
  9. Luby SP, Kadir MA, Yushuf Sharker MA, Yeasmin F, Unicomb L, Sirajul Islam M, , 2010. A community-randomised controlled trial promoting waterless hand sanitizer and handwashing with soap, Dhaka, Bangladesh. Trop Med Int Health 15: 15081516.
  10. Baker KK, 2014. Association between moderate-to-severe diarrhea in young children in the global enteric multicenter study (GEMS) and types of handwashing materials used by caretakers in Mirzapur, Bangladesh. Am J Trop Med Hyg 91: 181189.
  11. Curtis V, Cairncross S, Yonli R, , 2000. Domestic hygiene and diarrhoea—pinpointing the problem. Trop Med Int Health 5: 2232.
  12. Hoque B, , 2003. Handwashing practices and challenges in Bangladesh. Int J Environ Health Res 13: S81S87.
  13. Hoque B, Briend A, , 1991. A comparison of local handwashing agents in Bangladesh. J Trop Med Hyg 94: 6164.
  14. Hoque BA, Mahalanabis D, Alam MJ, Islam MS, , 1995. Post-defecation handwashing in Bangladesh: practice and efficiency perspectives. Public Health 109: 1524.
  15. Scott B, Curtis V, Rabie T, Garbrah-Aidoo N, , 2007. Health in our hands, but not in our heads: understanding hygiene motivation in Ghana. Health Policy Plan 22: 225233.
  16. Stanton BF, Clemens JD, , 1987. An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. II. A randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea. Am J Epidemiol 125: 292301.
  17. Hulland KR, Leontsini E, Dreibelbis R, Unicomb L, Afroz A, Dutta NC, Nizame FA, Luby SP, Ram PK, Winch PJ, , 2013. Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health 13: 877.
  18. Ashraf S, 2017. Nonrandomized trial of feasibility and acceptability of strategies for promotion of soapy water as a handwashing agent in rural Bangladesh. Am J Trop Med Hyg 96: 421429.
  19. Galiani S, Gertler P, Orsola-Vidal A, , 2012. Promoting Handwashing Behavior in Peru: The Effect of Large-Scale Mass-Media and Community Level Interventions. Available at: https://www.wsp.org/sites/wsp.org/files/publications/WSP-Promoting-Handwashing-Behavior-Peru-Mass-Media-Community-Level-Interventions.pdf. Accessed August 17, 2017.
  20. Saboori S, Mwaki A, Rheingans RD, , 2010. Is soapy water a viable solution for handwashing in schools? Waterlines 29: 329336.
  21. Christensen G, Dentz HN, Pickering AJ, Bourdier T, Arnold BF, Colford JM, Jr Null C, , 2015. Pilot cluster randomized controlled trials to evaluate adoption of water, sanitation, and hygiene interventions and their combination in rural western Kenya. Am J Trop Med Hyg 92: 437447.
  22. Biswas SK, , 2012. Uptake of hand washing with soap or soapy water from a large-scale cluster randomized community trial in urban Bangladesh. Health Sci Bull 10: 915.
  23. Martin NA, Hulland KRS, Dreibelbis R, Sultana F, Winch PJ, , 2017. Sustained adoption of water, sanitation and hygiene interventions: systematic review. Trop Med Int Health 23: 122135.
  24. Hanchett S, Akhter S, Khan MH, Mezulianik S, Blagbrough V, , 2003. Water, sanitation and hygiene in Bangladeshi slums: an evaluation of the WaterAid–Bangladesh urban programme. Environ Urban 15: 4356.
  25. Amin N, Crider YS, Unicomb L, Das KK, Gope PS, Mahmud ZH, Islam MS, Davis J, Luby SP, Pickering AJ, , 2016. Field trial of an automated batch chlorinator system at shared water points in an urban community of Dhaka, Bangladesh. J Water Sanit Hyg Dev 6: 3241.
  26. Luoto J, Najnin N, Mahmud M, Albert J, Islam MS, Luby S, Unicomb L, Levine DI, , 2011. What point-of-use water treatment products do consumers use? Evidence from a randomized controlled trial among the urban poor in Bangladesh. PLoS One 6: e26132.
  27. Pickering AJ, Crider Y, Amin N, Bauza V, Unicomb L, Davis J, Luby SP, , 2015. Differences in field effectiveness and adoption between a novel automated chlorination system and household manual chlorination of drinking water in Dhaka, Bangladesh: a randomized controlled trial. PLoS One 10: e0118397.
  28. Biran A, Jenkins MW, Dabrase P, Bhagwat I, , 2011. Patterns and determinants of communal latrine usage in urban poverty pockets in Bhopal, India. Trop Med Int Health 16: 854862.
  29. Heijnen M, Routray P, Torondel B, Clasen T, , 2015. Neighbour-shared versus communal latrines in urban slums: a cross-sectional study in Orissa, India exploring household demographics, accessibility, privacy, use and cleanliness. Trans R Soc Trop Med Hyg 109: 690699.
  30. Heijnen M, Routray P, Torondel B, Clasen T, , 2015. Shared sanitation versus individual household latrines in urban slums: a cross-sectional study in Orissa, India. Am J Trop Med Hyg 93: 263268.
  31. Katukiza AY, Ronteltap M, Niwagaba CB, Foppen JW, Kansiime F, Lens PN, , 2012. Sustainable sanitation technology options for urban slums. Biotechnol Adv 30: 964978.
  32. Nelson KB, Karver J, Kullman C, Graham JP, , 2014. User perceptions of shared sanitation among rural households in Indonesia and Bangladesh. PLoS One 9: e103886.
  33. Norman G, , 2011. When are Communal or Public Toilets an Appropriate Option. Available at: http://www.waterfund.go.ke/sanitation/Downloads/8.%20Communal%20Public%20Toilets%20(WSUP).pdf. Accessed August 17, 2017.
  34. Tumwebaze IK, Orach CG, Niwagaba C, Luthi C, Mosler HJ, , 2013. Sanitation facilities in Kampala slums, Uganda: users’ satisfaction and determinant factors. Int J Environ Health Res 23: 191204.
  35. 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.
  36. Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP, , 2013. The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health 13: 1015.
  37. Tumwebaze IK, Mosler HJ, , 2014. Shared toilet users’ collective cleaning and determinant factors in Kampala slums, Uganda. BMC Public Health 14: 1260.
  38. Mai MM, Rahman M, , 2011. Cultural sustainability of residential adjustment styles of semi-urban Abuja and core Dhaka neighborhoods. J Sustainable Dev Environ Prot 1: 4156.
  39. Guiteras RP, Levine DI, Luby SP, Polley TH, Khatun-e-Jannat K, Unicomb L, , 2016. Disgust, shame, and soapy water: tests of novel interventions to promote safe water and hygiene. J Assoc Environ Resour Econ 3: 321359.
  40. Struyk RSG, , 2009. The Challenge of an Urban World: An Opportunity for US Foreign Assistance. Available at: http://ihcglobal.org/wp-content/uploads/2016/04/The_Challenge_of_an_Urban_World.pdf. Accessed August 17, 2017.
  41. Bapat M, Agarwal I, , 2003. Our needs, our priorities; women and men from the slums in Mumbai and Pune talk about their needs for water and sanitation. Environ Urban 15: 7186.
  42. Heijnen M, Cumming O, Peletz R, Chan GK, Brown J, Baker K, Clasen T, , 2014. Shared sanitation versus individual household latrines: a systematic review of health outcomes. PLoS One 9: e93300.
  43. Abheuer T, Thiele-Eich I, Braun B, , 2013. Coping with the impacts of severe flood events in Dhaka’s slums—the role of social capital. Erdkunde 67: 2135.
  44. Ostrom E, , 2014. Collective action and the evolution of social norms. J Nat Resour Policy Res 6: 235252.
  45. Tumwebaze IK, Niwagaba CB, Günther I, Mosler H-J, , 2014. Determinants of households’ cleaning intention for shared toilets: case of 50 slums in Kampala, Uganda. Habitat Int 41: 108113.
  46. Tumwebaze IK, Mosler H-J, , 2015. Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums. Soc Sci Med 147: 7279.
  47. Yeasmin F, 2017. Piloting a low-cost hardware intervention to reduce improper disposal of solid waste in communal toilets in low-income settlements in Dhaka, Bangladesh. BMC Public Health 17: 682.
  48. Biran A, , 2011. Enabling Technologies for Handwashing with Soap: A Case Study on the Tippy-Tap in Uganda. Available at: https://www.wsp.org/sites/wsp.org/files/publications/uganda-tippy-tap-hwws.pdf. Accessed August 17, 2017.
  49. Alam M, Halder A, Horng L, , 2014. Bangladesh National Hygiene Baseline Survey Preliminary Report. Available at: https://assets.publishing.service.gov.uk/media/57a08990e5274a31e0000152/Research_Brief__Bangladesh-National-Hygiene-Baseline-Survey_Feb2015.pdf. Accessed August 17, 2017.
  50. Aunger R, Schmidt WP, Ranpura A, Coombes Y, Maina PM, Matiko CN, Curtis V, , 2010. Three kinds of psychological determinants for hand-washing behaviour in Kenya. Soc Sci Med 70: 383391.
  51. Verplanken B, , 2006. Beyond frequency: habit as mental construct. Br J Soc Psychol 45: 639656.
  52. Wood W, Quinn JM, Kashy DA, , 2002. Habits in everyday life: thought, emotion, and action. J Pers Soc Psychol 83: 12811297.
  53. Billings DL, Crane BB, Benson J, Solo J, Fetters T, , 2007. Scaling-up a public health innovation: a comparative study of post-abortion care in Bolivia and Mexico. Soc Sci Med 64: 22102222.
  54. Yamey G, , 2011. Scaling up global health interventions: a proposed framework for success. PLoS Med 8: e1001049.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0672
Loading
/content/journals/10.4269/ajtmh.17-0672
Loading

Data & Media loading...

  • Received : 24 Aug 2017
  • Accepted : 20 Apr 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error