Question

Observation table on comparison of cleanliness between two states of India

Answer 1

Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh Amal K Halder1*† , Carole Tronchet2 , Shamima Akhter1 , Abbas Bhuiya1 , Richard Johnston2 , Stephen P Luby1,3† Abstract Background: We analyzed data from the baseline assessment of a large intervention project to describe typical handwashing practices in rural Bangladesh, and compare measures of hand cleanliness with household characteristics. Methods: We randomly selected 100 villages from 36 districts in rural Bangladesh. Field workers identified 17 eligible households per village using systematic sampling. Field workers conducted 5-hour structured observations in 1000 households, and a cross-sectional assessment in 1692 households that included spot checks, an evaluation of hand cleanliness and a request that residents demonstrate their usual handwashing practices after defecation. Results: Although 47% of caregivers reported and 51% demonstrated washing both hands with soap after defecation, in structured observation, only 33% of caregivers and 14% of all persons observed washed both hands with soap after defecation. Less than 1% used soap and water for handwashing before eating and/or feeding a child. More commonly people washed their hands only with water, 23% after defecation and 5% before eating. Spot checks during the cross sectional survey classified 930 caregivers (55%) and 453 children (28%) as having clean appearing hands. In multivariate analysis economic status and water available at handwashing locations were significantly associated with hand cleanliness among both caregivers and children. Conclusions: A minority of rural Bangladeshi residents washed both hands with soap at key handwashing times, though rinsing hands with only water was more common. To realize the health benefits of handwashing, efforts to improve handwashing in these communities should target adding soap to current hand rinsing practices. Background The WHO estimates that 3.8 million children aged under five die each year from diarrhoea and acute respiratory tract infections [1]. Intervention studies consistently demonstrate that communities that received intensive handwashing promotion have less childhood diarrhea and respiratory disease [2-5]. People in Bangladesh commonly believe that soap is not necessary for handwashing, that water alone is effective in purifying hands, especially when hands appear clean [6]. The Government of Bangladesh (GoB) and UNICEF with the support of the Department for International Development (DFID) of the British Government instituted the Sanitation, Hygiene Education and Water supply-Bangladesh project (SHEWA-B) in 2007. This project, which targets some 30 million underserved people, is among the largest intensive handwashing, hygiene/ sanitation and water quality improvement programs ever attempted in a developing country. It aims to contribute towards achieving the Millennium Development Goals (MDGs) relating to water and sanitation. Understanding usual handwashing practices in rural Bangladesh is an important baseline assessment for the program. One of the major challenges with assessing handwashing behavior is that no measure has proven to be both practical and valid [7,8]. Although structured observation of handwashing practices is widely considered the best available method, it is expensive, time-consuming, and risks being unrepresentative of usual handwashing practices [9]. Inspection of hands to assess their cleanliness has been suggested as an indicator of hand hygiene [10,11] but there are limited data that * Correspondence: [email protected] † Contributed equally 1 International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh Full list of author information is available at the end of the article Halder et al. BMC Public Health 2010, 10:545  © 2010 Halder et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.