Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh

Abstract

Abstract. We conducted a nonrandomized trial of strategies to promote soapy water for handwashing in rural Bangladesh and measured uptake. We enrolled households with children < 3 years for three progressively intensive study arms: promotion of soapy water (N = 120), soapy water promotion plus handwashing stations (N = 103), and soapy water promotion, stations plus detergent refills (N = 90); we also enrolled control households (N = 72). Our handwashing stations included tap-fitted buckets and soapy water bottles. Community promoters visited households and held community meetings to demonstrate soapy water preparation and promote handwashing at key times. Field workers measured uptake 4 months later. In-depth interviews and focus group discussions assessed factors associated with uptake. More households had soapy water at the handwashing place in progressively intensive arms: 18% (promotion), 60% (promotion plus station), and 71% (promotion, station with refills). Compared with the promotion-only arm, more households that received stations had soapy water at the primary handwashing station (44%, P ≤ 0.001; 71%, P < 0.001 with station plus detergent refill). Qualitative findings highlighted several dimensions that affected use: contextual (shared courtyard), psychosocial (perceived value), and technology dimensions (ease of use, convenience). Soapy water may increase habitual handwashing by addressing barriers of cost and availability of handwashing agents near water sources. Further research should inform optimal strategies to scale-up soapy water as a handwashing agent to study health impact.

Achieving Equitable Uptake of Handwashing and Sanitation by Addressing Both Supply and Demand-based Constraints: Findings From a Randomized Controlled Trial in Rural Bangladesh&nbsp;

“…In rural Bangladesh, when free-of cost WASH technologies were provided alongwith behavior change promotion, poorer households exhibited the greatest improvement in handwashing and sanitation uptake compared with wealthier households. This nding is consistent to results found in a non-randomized trial in rural Bangladesh, where households with the highest handwashing uptake, as evidenced by presence of low-cost soap alternative, were the ones that received handwashing promotion along with some sort of products and equipment support versus households that received handwashing promotion only (47).…”

Effectiveness of a large‐scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh

“…Future intervention programmes that aim to increase handwashing should consider changing other physical and psychosocial drivers of handwashing in addition to the ones addressed in the ICVB study. Multiple factors can affect handwashing with soap: contextual (having a shared courtyard and the associated inconvenience), psychosocial (perceived value of handwashing), and technological (ease of use, handwashing station wear and tear) . In a qualitative study in rural Bangladesh, key informants stated that they purchased bar soap primarily for bathing and laundry because soap was perceived to be an expensive items that could not be used for all purposes, including handwashing, and some informants did not keep soap at the handwashing place in order to conserve soap .…”

“…The ICVB research team developed the handwashing behaviour change plan guided by the Integrated Behavioral Model for Water, Sanitation and Hygiene (IBM‐WASH) . Guided by the model and extensive formative research , the behaviour change intervention was designed to improve stable access to enabling technologies (handwashing stations and soapy water dispensers) placed conveniently in or around the home, increase handwashing skills of adults and children, build family and community support in maintaining the handwashing stations and replenishing supplies, influence community norms by modelling and supporting the behaviour in public, and provide periodic counselling and problem solving by trained community health workers. In Bangladesh, the cost of bar soap is perceived to be a barrier to frequent handwashing with soap ; a bar of soap costs 40 Taka (US $0.50) in a country where the minimum wage for a common occupation such as garment factory work is $67 per month .…”

Microbiological Evaluation of the Efficacy of Soapy Water to Clean Hands: A Randomized, Non-Inferiority Field Trial

“…14,15 Soapy water is currently being piloted in low-income rural 16 and urban 17 communities in Bangladesh 18 for acceptability and feasibility. To make soapy water, 30 g powdered detergent (Wheel, Unilever, Dhaka, Bangladesh) is mixed in any 1.5 L container, such as a reused water/soda/ juice bottle.…”

“…Preliminary qualitative research suggests that soapy water is popular because of its low cost and ease of preparation. 16 In Bangladesh, a 30 g sachet of powder laundry detergent costs US$0.03 compared with a common bar of soap (Lux, Unilever, Dhaka, Bangladesh), which costs US$0.35. The cost of freshly prepared soapy water is US$0.09 (detergent US$0.03 + plastic bottle US$0.06), and the cost of refilling an existing bottle is only US$0.03.…”