Senegal: behavioral determinants of handwashing with soap – emergent learning

A new Water and Sanitation Program (WSP) Learning Note found that beliefs and ease of access to soap and water were correlated with handwashing with soap behaviors for given proxy measures among mothers and caretakers in Peru and Senegal.

“Behavioral Determinants of Handwashing with Soap Among Mothers and Caretakers: Emergent Learning from Senegal and Peru,” is based on survey data from nearly 3,500 households in Peru and 1,500 households in Senegal. This data was analyzed using FOAM, a conceptual framework developed by WSP to help identify factors that might facilitate or impeded handwashing with soap practices at critical times.

The analysis revealed that the impact of different determinants varies depending on the chosen proxy measure, such as the presence of a handwashing station or its distance from kitchen or latrine facilities. Given this variability, the Learning Note found that program managers must clearly define the exact behavior they seek to improve before choosing which determinant to focus on in their formative research.

Mozambique – Effectiveness of Large Scale Water and Sanitation Interventions

Effectiveness of Large Scale Water and Sanitation Interventions: the One Million Initiative in Mozambique, October 2011.

• Full-text (pdf)

Chris Elbers, et al.

The One Million Initiative of the Government of Mozambique aims at supplying access to clean drinking water and adequate sanitation for one million people. The program has constructed hundreds of new boreholes and implemented trainings on sanitation in communities from three provinces. To evaluate the program, a panel survey design was set up with a baseline in 2008, a midterm in 2010 and an end-line in 2013. The survey covers interviews with 1600 households, focus group discussions about the community and water points in 80 clusters in 9 districts. To our knowledge this is the first rigorous evaluation of such a large scale program in the water and sanitation sector.

This paper summarizes the findings of the baseline and midterm surveys in terms of health impacts, latrine ownership and the use of improved water sources. Our results indicate that the water point intervention had a sizeable impact on the use of improved water sources and on the health outcome of children under 5 but no impact for older individuals, while the sanitation component of the program had a strong impact on latrine ownership and health outcome for older individuals, and a limited impact on hand-washing with soap and the use of improved water sources when it was available in the community

Kenya, Nairobi: hygiene promotion in schools improves handwashing behaviour

Schools that promote a healthy learning environment for pupils ensure that there is access to water and sanitation facilities and that teachers engage pupils frequently on discussions about health. In these schools the number of children who washed hands frequently increased from six percent to over 80 percent in a period of 10 months.

Researchers from the Nairobi-based African Population and Health Research Center (APHRC) worked with 22 primary schools in two informal settlements in Nairobi, Kenya under an initiative dubbed Health Promoting Schools (HPS). HPS is a World Health Organization (WHO) initiative that takes a holistic approach in integrating healthy behaviours into all aspects of school life.

Kenya, Nairobi: Unilever enrols 100,000 schoolchildren in handwashing drive

Unilever through its Lifebuoy soap brand has reached 100,000 students in over 80 schools across Nairobi County its hand washing campaign. The “School of Five” campaign aims to get over one million people across Kenya to pledge to the habit of washing their hands with soap on five occasion throughout the day with the help of trained school children and teachers. The campaign is being jointly implemented by Lifebuoy Kenya and Water and Sanitation for the Urban Poor (WSUP).

Lifebuoy School of Five poster

Unilever contracted popular Kenyan singer Esther Wahome, in a two-year “multi-million shilling” deal, to act us brand ambassador  for the Lifebuoy School of Five campaign. In line with the campaign. Mrs Wahome has released a handwashing jingle dubbed Osha Mikono (Wash your hands) to accompany the campaign.

A 2010 clean hands study conducted to check the hand washing habits of Kenyans found that only 15 per cent are aware of the proper hand washing techniques.

Visit the Lifebuoy Facebook page

Source: Stanley Njenga, Nairobi Star / allAfrica.com, 09 Jul 2011 ; Hot Secrets, 25 Apr 2011

Kenya: school children attempt to break world handwashing record

School children at Thirime primary school, Kikuyu, Kenya on Global Handwashing Day. Photo: Thomas Mukoya-Reuters

Close to 20,000 school children and adults took part in a handwashing campaign in an attempt to establish a new Guinness World Record. They gathered at Thirime Primary School in Kikuyu on 15 October 2010 to mark Global Handwashing Day.

Education Permanent Secretary James Ole Kiyiapi announced that 19,352 people, including 18,302 children and 1,050 adults washed their hands during the event. If recognised, this would break the previous record for the most number of people washing hands at a single venue set by 15,150 students in Chennai, India, in 2009. Plan Bangladesh and partners claim to hold the record for the most number of people washing hands at multiple locations, when 52,970 school children gathered across the country in October 2009.

West Africa: stopping cholera emergencies

Cholera outbreaks in West Africa generally trigger extra hand-washings in households and panic-buying of bleach for treating water. But beating the deadly – but easily preventable – illness requires that such hygiene practices become routine, health experts say.

Researchers with the London School of Hygiene and Tropical Medicine (LSHTM) say knowing the drivers behind behaviour and tying hygiene messages to those impulses is crucial for preventing cholera, which has become a recurring health emergency in West Africa.

“If we want sustainable change we need to make sure people practice things so they become habits,” Jeroen Ensink of LSHTM’s environmental health group told IRIN.

One way for aid agencies to do so, he said, is to dissociate hygiene messages from cholera – which is seasonal – and link them instead to general diarrhoeal disease.

Ensink also said it might be time to “re-brand” hygiene and health messages, as knowledge of cholera’s causes does not always translate into new habits. “Hand-washing messages need not be just about health; they can be about: if you want to be modern, to smell nice, to be attractive to the opposite sex, use soap.” The use of proper latrines can be linked to privacy instead of just proper hygiene, he added.

LSHTM has studied the impact of government and aid agency prevention and preparedness measures in Guinea and Guinea-Bissau as part of a project funded by the European Commission humanitarian aid department (ECHO).

Coherent

The ECHO project aims to build a more coherent approach to cholera control with sound preparedness and early response. And ECHO says ‘quick impact’ actions in vulnerable communities should be accompanied by longer-term prevention measures.

To date, emergency and development strategies fail to address the disease properly, lacking common objectives and complementary actions, ECHO says.

ECHO is focusing on Guinea and Guinea-Bissau, where cholera has become endemic; during 2007 and 2008 over 23,000 people were infected and 560 died in the two countries.

But all of West Africa is highly vulnerable to cholera and a regional approach is needed; ECHO and its partners will study lessons from Guinea and Guinea-Bissau to see what might be applied more widely.

As part of the ECHO-funded project UNICEF and NGOs are training local health workers in responding to cholera, boosting communications strategies and developing emergency kits, which include sanitation and water purification materials, to keep outbreaks in check.

[T]o be effective anti-cholera actions must not be merely reactive, health experts say. LSTHM researchers observed in Guinea-Bissau that while most people could recite verbatim hand-washing and other hygiene messages, they apply them consistently only when cholera strikes. Changing such behaviour takes years, not months, said LSHTM’s Ensink.

Source: IRIN, 15 Oct 2009

Uganda, Kasese: unwashed hands cause cholera

Persistent outbreaks of cholera in Kasese District have been blamed on poor hand-washing practices and bad eating habits. This was noted at a one-day advocacy meeting for district councillors on water and sanitation held in Kasese Catholic Social Hall on Thursday [01 October 2009].

Presenting a latrine coverage and hand-washing situational analysis in Kasese, the district health inspector also the disease surveillance officer, Ericana Bwambale, said washing hands among the people of Kasese ranged from 17% to 34%. He named the sub-counties where people rarely wash their hands as Muhokya with 17%, followed by Kitswamba at 18% and Rukoki at 20%.

He said Kyabarungira Sub-county has the lowest latrine coverage at 57%, followed by Rukoki at 60% and Kisinga at 65%. Kyondo Sub-county had the highest latrine coverage of 88%, followed by Maliba Sub-county at 87%.

He said the majority of the people in Kasese eat whatever food they come across without considering its cleanliness.

Since March [2009], 500 cases of cholera have been reported in Kasese with about 10 deaths. The Busongora County health inspector, Steven Bagonza, said cholera cases have been reported in all the four constituencies in the district.

The district councillors on the technical and social services committee blamed the sub-county health assistants for the deteriorating health conditions in the district. They said health workers were not sensitising the community on the need to improve sanitation and hygiene in their homes.

The head of the district technical and social services committee, Mustafa Kikusa, said all the sub-county health assistants should be summoned before the district committee and explain why they are failing to do their work. He noted that the Government was doing all it could to improve people’s standards of living but was being frustrated by civil servants who are failing to deliver as expected.

During the meeting, it was reported that people of Kasese were feeding on animal offals and fish skeletons from Kampala that have some times compromised the health of the people.

The furious councillors promised to move a motion to ban the sale of offals and skeleton fish in the district, saying they were unhygienic and partly responsible for the deteriorating health conditions.

However, some councillors on the committee, especially women said that they would block the motion if brought to council, adding that majority of the people in the district were surviving on offals and fish skeletons because they were cheap and some people cannot afford meat.

Source: Bernard Masereka, New Vision / allAfrica.com, 03 Oct 2009