Impact of an Intensive Perinatal Handwashing Promotion Intervention on Maternal Handwashing Behavior in the Neonatal Period: Findings from a Randomized Controlled Trial in Rural Bangladesh

Abstract

One-quarter of neonatal deaths are attributed to infections. Maternal handwashing with soap may prevent neonatal sepsis. We examined impact of intensive handwashing promotion on handwashing behavior of mothers of neonates. In Matlab, Bangladesh, we randomly allocated pregnant women at 28–32 weeks' gestation to intensive handwashing promotion or control. Behavior change communicators used a participatory approach to motivate maternal handwashing with soap and provided soap and handwashing stations. In the neonatal period, we observed soap and water at handwashing places and, at the end of the neonatal period, we estimated impact on maternal handwashing by structured observation. Among 253 women enrolled, intervention households were between 5.7 and 15.2 times as likely as control households to have soap and water present at the handwashing station in the baby's sleeping area. Intervention mothers washed hands with soap 4.1 times as frequently as controls (95% CI 2.55–6.59); handwashing with soap at recommended times was infrequent in both intervention (9%) and control (2%) groups. Intensively promoting handwashing with soap resulted in increased availability of soap and water at handwashing places, but only a modest increase in maternal handwashing with soap. Novel approaches to motivating handwashing behavior to protect newborns should be developed and evaluated.

Is pregnancy a teachable moment to promote handwashing with soap among primiparous women in rural Bangladesh? Follow‐up of a randomised controlled trial

“…Despite the low frequency of handwashing in both treatment arms, in the parent study, the handwashing programme was significant associated with improved maternal handwashing, but the difference was not maintained in the Teachable Moment study . In the Teachable Moment study, we hypothesised that women experiencing a potential teachable moment (pregnancy and the neonatal period) may be more likely to adopt and maintain improved handwashing behaviours than women who were not experiencing that teachable moment and exposed to the same intervention.…”

“…We promoted handwashing with soap as a nurturing behaviour because nurturing is a nearly universal aspiration for mothers and we hypothesised it would be a strong motivator . However, results from the parent study, which assessed the impact of the handwashing promotion on behaviour in the neonatal period, reported the frequency of handwashing was low overall . The low impact of the intervention during the neonatal period may have limited our ability to assess the impact of the teachable moment on sustained behaviour change.…”

“…We hypothesised these changes would support a mother to make a conscious decision to wash her hands until the practice developed into a habit . Although handwashing at key events was more frequently observed in both treatment arms in the Teachable Moment Study (4.6%) than before exposure to the intervention (1% in the post‐neonatal arm during the parent study), it waned over time . Some deterioration may be due to changes in barriers and motivators to washing hands as the child matures that were not addressed by the intervention.…”

“…This study is an observational follow‐up from a randomised controlled trial, the Perinatal Handwashing Study conducted in 2010–2011, hereafter referred to as the parent study . The objective of the parent study was to estimate the impact of an intensive handwashing intervention on maternal handwashing behaviour in the neonatal period among primiparous women in Matlab, Bangladesh, a rural area 55 km southeast of Dhaka.…”

“…Women in both arms received maternal and newborn health counselling. Participants were followed for 3 months after birth (delivery date November 2010 – September 15, 2011) or 1 month after birth (delivery date September 16, 2011 – November 15, 2011) . After data collection was complete for the parent study, behaviour change communicators provided the handwashing intervention to women in the control arm because improved maternal handwashing has health benefits beyond the neonatal period (Figure ) .…”