Difficulties in Maintaining Improved Handwashing Behavior, Karachi, Pakistan

Abstract

In an earlier study in Karachi, Pakistan, households that received free soap and handwashing promotion for 9 months reported 53% less diarrhea than controls. Eighteen months after the intervention ended, these households were enrolled in a follow-up study to assess sustainability of handwashing behavior. Upon re-enrollment, mothers in households originally assigned to the intervention were 1.5 times more likely to have a place with soap and water to wash hands (79% versus 53%, P = 0.001) and when asked to wash hands were 2.2 times more likely to rub their hands together at least three times (50% versus 23%, P = 0.002) compared with controls. In the ensuing 14 months, former intervention households reported a similar proportion of person-days with diarrhea (1.59% versus 1.88%, P = 0.66) as controls. Although intervention households showed better handwashing technique after 2 years without intervention, their soap purchases and diarrhea experience was not significantly different from controls.

A Cluster Randomized Controlled Evaluation of the Health Impact of a Novel Antimicrobial Hand Towel on the Health of Children Under 2 Years Old in Rural Communities in Nyanza Province, Kenya

“…We collected no objective data that verified whether handwashing frequency actually increased in intervention households, but, given the challenges in motivating and sustaining handwashing behavior, the use of hand towels as a behavioral cue merits further study. 5 The promotion and use of clean towels for hand drying could improve the effectiveness of handwashing because previous research suggests that, despite promotion of air-drying as a safe hand drying method, the behavior is often not practiced, most likely because it is time consuming and inconvenient. 6 More vigorous promotion of hand towels based on the results of this study would also require promotion of frequent (i.e., at least daily) towel washing and drying to prevent contamination and potential disease transmission.…”

“…3,4 However, at least one study has documented the difficulty of sustaining handwashing behaviors and the attendant health impact. 5 Furthermore, a qualitative study of hand drying behavior in western Kenya suggested that, despite widespread messaging about the importance of using clean towels or air drying after handwashing, many people tended to use their pants or wraparound skirts for hand drying. 6 In response to the challenge of promoting and sustaining effective handwashing, innovative technologies for improving hand hygiene have been developed that consist of reusable hand towels with antimicrobial properties that are nontoxic and stable over time.…”

“…Previous research utilizing handculturing techniques suggests that documenting the impact of handwashing on hand contamination in fecal-contaminated environments is challenging. 5,8 Understanding the acceptability of novel interventions to community members enables changes to be made to products early in their development, including the impact of product maintenance. To further evaluate the potential of antimicrobial hand towels as a hygiene intervention in a contaminated environment, we examined the use, acceptability, and health impact of the Vestergaard-Frandsen towels in rural western Kenya over a period of 1 year.…”

Non Medical Interventions for Childhood Diarrhoea Control:Way Forward in Nepal

“…Luby et al in their follow up in 2009 reported that sustainability of the project was limited. 21 They found that despite increased awareness of appropriate techniques of hand washing in the intervention areas; the hand washing behaviour was declined and purchasing soap for the purpose did not increase significantly. They concluded that it was the limitation of the project which didn't focused on increasing willingness and motivation to purchase and use soap.…”

“…They concluded that it was the limitation of the project which didn't focused on increasing willingness and motivation to purchase and use soap. 21 …”