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Abstractobjectives To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children's school absenteeism.methods We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm).results Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (À25%, 95% confidence intervals [CI] = À37%, À2%), ARIs (À15%, 95% CI = À30%, À8%), school absences due to illnesses (À27%, 95% CI = À41%, À18%) and eye infections (À46%, 95% CI = À58%, À31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for 'whole families' (À31%, 95% CI = À37%, À5%; and À14%, 95% CI = À23%, À6%, respectively), 6-to 15-year-olds (À30%, 95% CI = À39%, À7%; and À15%, 95% CI = À24%, À6%) and under 5 s (À32%, 95% CI = À41%, À4%; and À20%, 95% CI = À29%, À8%).conclusions Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.keywords hand washing with soap, diarrhoea, acute respiratory infection, hygiene, school absence

Poor handwashing behavior is a major cause of morbidity and mortality globally. We evaluated two complementary mass-scale media interventions targeting mothers to increase the frequency of handwashing with soap; one using TV advertising, and the other mobile phone messaging. Television Commercials (TVCs): Mothers of 4-12 year-old children (n = 756) were randomly allocated among four arms: Three different branded TVCs and a fourth, control TVC unrelated to handwashing. TVCs were embedded in blocks of unrelated commercials and shown once a week over four weeks in participants' own homes. Mobile messages: New mothers (n = 598) and mothers of 4-7 year-old children (n = 501) were enrolled in a treatment or control arm. Mothers in the treatment arm received branded mobile phone messages twice weekly for 8 weeks (new mothers) or 4 weeks (mothers of 4-7 year-olds). For TVCs, there were higher rates of handwashing with soap at key occasions in the first (RR: 1.33, p = .002) and second (RR: 1.26, p = .041) of three treatment arms, or 0.4 additional handwashes with soap on key occasions daily. In the mobile study, new mothers (adj-RR: 1.04, p = .035) and general mothers (RR: 1.07, p = .007) receiving the intervention were more likely to wash their hands with soap on key occasions than those in the control group, corresponding to 1.3 and 1.0 more occasions daily. These interventions were associated with significantly greater handwashing with soap, consistent with the hypothesis that branded mass communications can impact habitual lifestyle behaviors relevant to public health.

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled ‘Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability’. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today’s environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes – particularly in developing and emerging countries – imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public–private partnerships.

Trachoma is the leading infectious cause of blindness, and facial cleanliness is associated with reduced odds of trachomatous inflammation and Chlamydia trachomatis infection, but there is little evidence of how to drive this behavior change at scale. We report the results of a program integrating face washing into a school-based handwashing promotion program in Turkana County, Kenya. Children aged 5-15 years participated in an intervention delivered to schools in two phases, along with a third phase receiving the intervention after the evaluation, which served as a control. The primary outcome was the number of face washing events that took place when handwashing occurred, which was measured by a 3-hour structured observation at all 67 schools, and a total of 3,871 handwashing events were observed. Differences in observed in face washing behavior between each phase and the control schools were calculated using logbinomial regression with clustering at the school level, whereas survey responses on knowledge of trachoma transmission and prevention were compared using χ 2 tests adjusted for clustering at the school level. Face washing during handwashing events was higher in schools after 12 months (59.3%) and 20 months (44.2%) than in control schools (18.7%, P < 0.001). Trachoma knowledge was higher in schools evaluated after 12 months (80%) and 20 months (70%) than in control schools (42%, P < 0.001), and knowledge of some of key preventive behaviors was higher in intervention schools. Integrating face washing messages into school-based handwashing promotion programs increased face washing, which may help to prevent trachoma when combined with other interventions.