Could Alcohol-Based Hand Sanitizer Be an Option for Hand Hygiene for Households in Rural Bangladesh?

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  • 1 International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh;
  • 2 The Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania;
  • 3 Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York;
  • 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
  • 5 Stanford University, Stanford, California

In low- and middle-income countries (LMICs), hand sanitizer may be a convenient alternative to soap and water to increase hand hygiene practices. We explored perceptions, acceptability, and use of hand sanitizer in rural Bangladesh. We enrolled 120 households from three rural villages. Promoters distributed free alcohol-based hand sanitizer, installed handwashing stations (bucket with tap, stand, basin, and bottle for soapy water), and conducted household visits and community meetings. During Phase 1, promoters recommended handwashing with soap or soapy water, or hand sanitizer after defecation, after cleaning a child’s anus/feces, and before food preparation. In Phase 2, they recommended separate key times for hand sanitizer: before touching a child ≤ 6 months and after returning home. Three to 4 months after each intervention phase, we conducted a survey, in-depth interviews, and group discussions with child caregivers and male household members. After Phase 1, 82/89 (92%) households reported handwashing with soap after defecation versus 38 (43%) reported hand sanitizer use. Participants thought soap and water removed dirt from their hands, whereas hand sanitizer killed germs. In Phase 2, 76/87 (87%) reported using hand sanitizer after returning home and 71/87 (82%) before touching a child ≤ 6 months. Qualitative study participants reported that Phase 2–recommended times for hand sanitizer use were acceptable, but handwashing with soap was preferred over hand sanitizer when there was uncertainty over choosing between the two. Hand sanitizer use was liked by household members and has potential for use in LMICs, including during the coronavirus pandemic.

Author Notes

Address correspondence to Dalia Yeasmin, Program of Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh. E-mails: daliay@icddrb.org or daliayeasmin@gmail.com

Financial support: This research was financially supported by Global Development grant OPPGD759 from the Bill & Melinda Gates Foundation.

Authors’ addresses: Dalia Yeasmin and Notan C. Dutta, Emerging Infections, Infectious Diseases Division, icddr, b, Dhaka, Bangladesh, E-mails: daliay@icddrb.org or daliayeasmin@gmail.com and duttanotan@gmail.com. Fosiul A. Nizame, Musarrat J. Rahman, Mahbubur Rahman, and Leanne Unicomb, Environmental Interventions Unit, Infectious Diseases Division, icddr, b, Dhaka, Bangladesh, E-mails: fosiul@icddrb.org, musarrat@gmail.com, mahbubr@icddrb.org, and leanne@icddrb.org. Sania Ashraf, The Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA, E-mail: asania@upenn.edu. Pavani K. Ram, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, E-mail: pkram@buffalo.edu. Elli Leontsini and Peter J. Winch, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: eleontsi@jhu.edu and pwinch@jhu.edu. Stephen P. Luby, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu.

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