A pilot study of the effect of improved hygiene kits on handwashing with soap among internally displaced persons in Ethiopia.

Abstract

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)