Issue 38 January 13, 2012 | Year in Review - 10 Key Handwashing Studies From 2011
 

This issue of the WASHplus Weekly highlights 10 selected peer-review studies and reports on handwashing that were published in 2011. One study (Blencowe) of postnatal maternal handwashing reported reductions in neonatal deaths. A research article from Bangladesh (Luby) concludes that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea. Another study (Luby) assessed which practical handwashing indicators were independently associated with reduced child diarrhea or respiratory disease.  A handwashing program in Vietnamese schools (Dutton) Dutton used the entertainment education approach to develop games and activities as extracurricular activities that would complement rather than compete with the existing curriculum. Please let WASHplus know if you have other recent resources on handwashing or if you have suggestions for future issues of the Weekly. 
 

ARTICLES/REPORTS

• Anal Cleansing Practices and Faecal Contamination: A Preliminary Investigation of Behaviours and Conditions in Schools in Rural Nyanza Province, Kenya, Trop Med Int Health. 2011 Sept. S McMahon, Emory University. (Abstract)
  Anal cleansing is a necessary human activity. However, because of social taboos, there are few articles on the topic. School health plans overlook it as well. Researchers need to determine if and how current practices could harm child health to inform policy.
   
• Bacterial Hand Contamination Among Tanzanian Mothers Varies Temporally and Following Household Activities, Trop Med Int Health, Feb 2011. AJ Pickering, Stanford University. (Abstract)
  The objective of this study was to assess the presence of selected pathogens on mothers' hands in Tanzania. It found that Escherichia coli and enterococci on hands can be significantly increased by various household activities, including those involving the use of soap and water. Thus, fecal indicator bacteria should be considered highly variable when used as indicators of handwashing behavior. This work corroborates hands as important vectors of disease among Tanzanian mothers and highlights the difficulty of good personal hygiene in an environment characterized by the lack of networked sanitation and water supply services.
   
• Clean Birth and Postnatal Care Practices to Reduce Neonatal Deaths from Sepsis and Tetanus: a Systematic Review and Delphi Estimation of Mortality Effect, BMC Public Health, Apr 2011. H Blencowe H, London School of Hygiene and Tropical Medicine. (Full-text)
  Annually over 520,000 newborns die from neonatal sepsis, and 60,000 more from tetanus. A study of postnatal maternal handwashing reported reductions in all-cause mortality and cord infection. According to expert opinion, clean birth and particularly postnatal care practices are effective in reducing neonatal mortality from sepsis and tetanus. Further research is required regarding optimal implementation strategies.
   
• The Effect of Handwashing at Recommended Times with Water Alone and with Soap on Child Diarrhea in Rural Bangladesh: An Observational Study, PLoS Med, June 2011. S Luby, International Centre for Diarrhoeal Disease Research. (Full-text)
  This study concludes that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea, and that handwashing with water alone can significantly reduce childhood diarrhea.
   
• The Effectiveness and Sustainability of Two Demand Driven Sanitation and Hygiene Approaches in Zimbabwe, Journal of Water, Sanitation and Hygiene for Development, 1(1) 201. L Whaley, National Institute for Water and Sanitation, India. (Full-text)
  This study reports on a set of findings and conclusions concerning the effectiveness and sustainability of two such approaches operating in Zimbabwe, the community health club (CHC) approach and community-led total sanitation (CLTS). While both approaches effectively encouraged measures that combat open defecation, only health clubs witnessed a significant increase in the adoption of hand washing. CLTS proved more effective in promoting latrine construction, suggesting that the emphasis the CHCs place on hygiene practices such as handwashing needs to be coupled with an even stronger focus on the issue of sanitation brought by CLTS.
   
• Interim Evaluation of a Large Scale Sanitation, Hygiene and Water Improvement Programme on Childhood Diarrhea and Respiratory Disease in Rural Bangladesh, Soc Sci Med. Dec 2011. T Huda, International Centre for Diarrheal Diseases Research, Bangladesh. (Abstract)
  Started in 2007, the Sanitation Hygiene Education and Water Supply in Bangladesh (SHEWA-B) project aims to improve the hygiene, sanitation and water supply for 20 million people in Bangladesh, and thus reduce disease among this population. This paper assesses the effectiveness of SHEWA-B on changing behaviors and reducing diarrhea and respiratory illness among children < 5 years of age. Participants washed their hands with soap < 3% of the time around food related events in both intervention and control households at baseline and after 18 months. This large scale sanitation, hygiene and water improvement program resulted in improvements in a few of its targeted behaviors, but these modest behavior changes have not yet resulted in a measurable reduction in childhood diarrhea and respiratory illness.
   
• The Power of Primary Schools to Change and Sustain Handwashing with Soap Among Children: The Cases of Vietnam and Peru, 2011. P Dutton, Water and Sanitation Program. (Full-text)
  In Vietnam and Peru, handwashing initiatives within the primary school setting, are increasing students’ handwashing with soap rates by using entertainment education approaches. In Vietnam, the Women’s Union facilitated the training of 1,200 headmasters and teachers who carried out handwashing activities in over 600 schools in 15 provinces across the country. In total, over 340,000 students were reached. In Peru, the Handwashing Initiative was mainstreamed into the Ministry of Education’s system, through the Safe, Clean and Healthy Schools Program that was implemented in 24 regions and trained 14,000 teachers who worked with 285,000 students.
   
• Systematic Review: Handwashing Behaviour in Low to Middle Income Countries: Outcome Measures and Behaviour Maintenance, Trop Med Int Health, Apr 2011. S Vindigni, Emory University School of Medicine. (Full-text)
  This article describes global approaches to handwashing research in low- and middle-income communities using behavioral outcome measurement and temporal study design. It concludes that while the literature is replete with a variety of handwashing studies in community, school and health care settings, none have been able to definitively document long-term behavior change, thereby challenging the sustainability of various interventions. Additionally, there is a need to better understand which research approach is most effective in promoting long-term behavior compliance in global low- and middle-income settings.
   
• Using Child Health Outcomes to Identify Effective Measures of Handwashing, Am J Trop Med Hyg, Nov 2011. S Luby, ICDDR. (Abstract)
  This study assessed which practical handwashing indicators were independently associated with reduced child diarrhea or respiratory disease. In multivariate analysis, three handwashing indicators were independently associated with less child diarrhea--mothers reporting usually washing hands with soap before feeding a child, mothers using soap when asked to show how they usually washed their hands after defecation, and children having visibly clean finger pads. Two indicators were independently associated with fewer respiratory infections--mothers allowing their hands to air dry after the handwashing demonstration and the presence of water where the respondents usually wash hands after defecation. These rapid handwashing indicators should be considered for inclusion in handwashing assessments.
   
• Vietnam: A Handwashing Behavior Change Journey for the Caretakers’ Program, 2011. Water and Sanitation Program. (Full-text)
  Some of the findings from this study include that in order to design an effective behavior change program, formative research must be conducted to inform development of the communications strategy, program interventions and the monitoring and evaluation system. The availability of a handwashing station can act as a reminder to practice the behavior and serve to facilitate the behavior. Also, as the target audiences move beyond knowledge, communication messages must also be adjusted to ensure that they are relevant and persuasive and having effective monitoring systems is critical to inform these decisions.

OTHER WEEKLIES ON HANDWASHING

• October 7, 2011 - Focus on Hand Washing – Global Handwashing Day Edition
• April 8, 2011 – Focus on Hand Washing

Each WASHplus Weekly highlights topics such as Urban WASH, Indoor Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, Integration, and more. If you would like to feature your organization's materials in upcoming issues, please send them to Dan Campbell, WASHplus knowledge resources specialist, at  dacampbell@fhi360.org.