An exploratory pilot study of the effect of modified hygiene kits on handwashing with soap among internally displaced persons in Ethiopia.

Abstract

Background Internally displaced persons (IDPs) forced to flee from their homes due to conflict and drought are at particular risk of morbidity and mortality due to diarrhoeal diseases. Regular handwashing with soap could substantially reduce the risk of these infections, but the behaviour is challenging to practice while living in resource-poor, informal settlements. To mitigate these challenges, humanitarian aid organisations distribute hygiene kits including soap and handwashing infrastructure. Our study aimed to assess the effect of modified hygiene kits on handwashing behaviours among IDPs in Moyale, Ethiopia. Methods The pilot study evaluated three interventions separately; liquid soap, a ‘good quality’ scented bar soap and a mirror as modifications to a standard hygiene kit. The hygiene kit was distributed to four study arms, with three of the arms receiving one of the interventions in addition. Three to six weeks after distribution, behaviour change and perceptions of the interventions was assessed through structured observations, surveys and focus group discussions. Results At follow-up, handwashing with soap was rare at key times in all study arms. In the arm that received liquid soap, handwashing with soap was seen at 20% of key times but this was not indicated significantly different to the control arm were a prevalence of 17% (p-value=0.348). In the two other intervention arms prevalence was <11%. Participants in FGDs indicated that the liquid soap, scented bar soap and the mirror made handwashing more desirable. In contrast the standard bar soap distributed in hygiene kits was not viewed as being nice to use. Conclusion This study did not identify any effect of the modified kits on handwashing behaviour. However, it did indicate that there is value in better understanding hygiene product preferences as this may contribute to increased acceptability and use among crisis-affected populations. The challenges of doing research in conflict-affected regions had considerable implications on the design and implementation of this study.Trial registration The trial was registered at www.ClinicalTrials.gov 6 September 2019 (reg no: NCT04078633)