Handwashing promotion in humanitarian emergencies: strategies and challenges according to experts

Abstract

Diarrhea and acute respiratory infections account for nearly 30% of deaths among children displaced by humanitarian emergencies. Handwashing with soap reduces the risk of diarrhea and acute respiratory infection in non-emergency settings. However, the practice and the effectiveness of handwashing promotion efforts and the health benefits are not well documented in emergency settings. We conducted key informant interviews with 12 experts working in water, sanitation, and hygiene and examined current approaches, challenges, and knowledge gaps in relation to handwashing promotion in emergency settings. We identified many constraints to implementing effective handwashing promotion efforts including a failure to define objectives and targets for improvements in handwashing rates, lack of technical expertise and attention to the development and implementation of effective behavior change communication approaches, and limited understanding of the appropriateness, use, and acceptability of different handwashing hardware. Respondents identified multiple knowledge gaps and research needs that could improve current efforts. Collaborations between response agencies and research institutions could generate high quality data and facilitate contextualized and potentially more effective and robust handwashing promotion strategies.

Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia

“…For example, most participants believed firmly that nationwide uniformity of key messages (on posters and radio) was important to avoid confusion and encourage behaviour change. Similar findings have been reported in other emergency settings [44]. We suggest that the real reasons might be related to a desire to demonstrate strong leadership in a time of crises, and that more research is needed into uniform versus tailored messaging before this becomes accepted as standard practice in future outbreak emergencies.…”

“…By coding the results under the five stages of 'theorydriven' programme design, we identified differences between the processes used during this Ebola outbreak and the methods developed for designing, implementing and evaluating behaviour change interventions in non-outbreak settings. Vujcic et.al [44]. documented humanitarian perspectives on the design of hygiene programs for displaced and refugee populations.…”

Distribution of hygiene kits during a cholera outbreak in Kasaï-Oriental, Democratic Republic of Congo: a process evaluation

“…Cholera contamination in the household can be sustained whilst cases are shedding bacteria for up to 14 days after onset of symptoms [20], and maintained use of interventions is required to reduce transmission [84]. This questions the use of standardised kits for variable household sizes, and suggests the additional need for contextual adaptations to be made to WASH intervention design considering household sizes, preferences and cultural norms [85].…”

Short-term WASH interventions in emergency response: a systematic review

“…The hand sanitizer significantly reduced bacterial loading (1.7 log reduction, 95% CI 0.6-2.4 log reduction, p<0.001) and was deemed effective for areas without access to potable water. The absence of relevant handwashing studies is aligned with recent research attempted to review handwashing in emergencies (Vujcic, Ram, and Blum 2015). The scope of work of that research was adjusted when virtually no impact evaluations or information on promotional strategies were found.…”