BackgroundDiarrhoea is one of the most common causes of mortality and morbidity among populations displaced due to conflict. Handwashing with soap has the potential to halve the burden of diarrhoeal diseases in crisis contexts. This study aimed to identify which determinants drive handwashing behaviour in post-conflict, displacement camps. MethodsThis study was conducted in two camps for internally displaced people in the Kurdistan Region of Iraq. A Barrier Analysis questionnaire was used for assessing the determinants of hand washing behaviour. Participants were screened and classified as either 'doers' (those who wash their hands with soap at critical times) or 'non-doers' (those who do not wash their hands with soap at critical times). Forty-five doers and non-doers were randomly selected from each camp and asked about behavioural determinants. The Barrier Analysis standard tabulation sheet was used for the analysis. ResultsNo differences were observed between doers and non-doers in relation to self-efficacy, action efficacy, the difficulties and benefits of handwashing, and levels of access to soap and water. In the first of the two camps, non-doers found it harder to remember to wash their hands (P = 0.045), had lower perceived vulnerability to diarrhoea (P = 0.037), lower perceived severity of diarrhoea (P = 0.020) and were aware of 'policies' which supported handwashing with soap (P = 0.037). In the second camp non-doers had lower perceived vulnerability to diarrhoea (P = 0.017). ConclusionsIn these camp settings handwashing behaviour, and the factors that determine it, was relatively homogenous because of the homogeneity of the settings and the socio-demographics

Background Internally displaced persons (IDPs) forced to flee from their homes due to conflict and drought are at particular risk of morbidity and mortality due to diarrhoeal diseases. Regular handwashing with soap could substantially reduce the risk of these infections, but the behaviour is challenging to practice routinely while living in resource-poor, informal settlements. To mitigate these challenges, humanitarian aid organisations distribute hygiene kits including soap and handwashing infrastructure. Our study aimed to assess the effect of improved kits on handwashing behaviours among IDPs in Moyale, Ethiopia. Methods The pilot study evaluated three interventions separately; liquid soap, a good quality scented bar soap and a mirror as additions to a regular hygiene kit. The kit was distributed to all study groups, with 3 of the study groups receiving one of the interventions each. Three to six weeks after distribution, behaviour change was assessed through structured observations, surveys and focus group discussions. Results Handwashing with soap was rare at key times both in all study groups. In the group that received liquid soap, handwashing with soap was seen at 20% of key times. In the control arm this was 17%, while in the two other intervention arms prevalence was <11%. Both quantitative and qualitative data collection indicated that liquid soap encourages handwashing with soap at key times. The good quality scented bar soap and mirror were not found to have an observed effect on behaviour but were viewed as desirable by participants who also reported that the standard bar soap distributed in hygiene kits was not nice to use. Conclusion This study was to our knowledge the first randomised intervention study on handwashing among IDPs living in a non-camp setting. The study shows that improved kits have potential to make handwashing more desirable and easier to practice, and further research including formative assessments prior to the design of hygiene kits should be conducted to ensure maximal uptake. The challenges of doing research in conflict-affected regions had considerable implications on the design and implementation of this study.Trial registration The trial was registered at www.ClinicalTrials.gov 6 September 2019 (reg no: NCT04078633)

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Background Internally displaced persons (IDPs) forced to flee from their homes due to conflict and drought are at particular risk of morbidity and mortality due to diarrhoeal diseases. Regular handwashing with soap could substantially reduce the risk of these infections, but the behaviour is challenging to practice while living in resource-poor, informal settlements. To mitigate these challenges, humanitarian aid organisations distribute hygiene kits including soap and handwashing infrastructure. Our study aimed to assess the effect of modified hygiene kits on handwashing behaviours among IDPs in Moyale, Ethiopia. Methods The pilot study evaluated three interventions separately; liquid soap, a ‘good quality’ scented bar soap and a mirror as modifications to a standard hygiene kit. The hygiene kit was distributed to four study arms, with three of the arms receiving one of the interventions in addition. Three to six weeks after distribution, behaviour change and perceptions of the interventions was assessed through structured observations, surveys and focus group discussions. Results At follow-up, handwashing with soap was rare at key times in all study arms. In the arm that received liquid soap, handwashing with soap was seen at 20% of key times but this was not indicated significantly different to the control arm were a prevalence of 17% (p-value=0.348). In the two other intervention arms prevalence was <11%. Participants in FGDs indicated that the liquid soap, scented bar soap and the mirror made handwashing more desirable. In contrast the standard bar soap distributed in hygiene kits was not viewed as being nice to use. Conclusion This study did not identify any effect of the modified kits on handwashing behaviour. However, it did indicate that there is value in better understanding hygiene product preferences as this may contribute to increased acceptability and use among crisis-affected populations. The challenges of doing research in conflict-affected regions had considerable implications on the design and implementation of this study.Trial registration The trial was registered at www.ClinicalTrials.gov 6 September 2019 (reg no: NCT04078633)