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

Abstract

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.

Evaluating knowledge, awareness and associated water usage towards hand hygiene practices influenced by the current COVID-19 pandemic in Bangladesh

“…They observed that consumer perception of the products’ preventive effects against COVID-19 was higher for liquid hand soap and hand sanitizer than that was for normal bar soap. Hand sanitizer use was also liked by household members in rural Bangladesh during the coronavirus pandemic ( Yeasmin et al, 2021 ). Yeasmin et al (2021) reported that participants of their study thought soap and water eliminated dirt from their hands while hand sanitizer killed germs.…”

“…Hand sanitizer use was also liked by household members in rural Bangladesh during the coronavirus pandemic ( Yeasmin et al, 2021 ). Yeasmin et al (2021) reported that participants of their study thought soap and water eliminated dirt from their hands while hand sanitizer killed germs. However, a sufficient volume of alcohol-based hand rub is recommended for sanitizing hands when water and soap are not available.…”

Acceptability measures of water, sanitation and hygiene interventions in low- and middle-income countries, a systematic review

“…Some authors used validated behavioural frameworks, such as the health belief model (HBM) and the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH), to design their acceptability measures [ 35 , 36 , 44 ]. IBM-WASH is a tool designed to identify and address individual and contextual factors that affect behavioural outcomes for WASH interventions [ 25 ].…”

Investigating the Efficacy of Various Handwashing Methods against Enveloped and Non-Enveloped Viruses

“…Pathogens can be transmitted through direct transmission (direct contact or droplet spread) or may spread through indirect transmission (contaminated food, water, or inanimate surfaces). [3][4][5][6] Hands play a role in indirect transmission; they can act as vehicles for pathogens between infected individuals and as environmental reservoirs to susceptible individuals. 6,7 Hand hygiene has been suggested as the most costeffective and efficient means of reducing the global burden of disease by the WHO and the Centers for Disease Control and Prevention (CDC).…”