Observed Practices and Perceived Advantages of Different Hand Cleansing Agents in Rural Bangladesh: Ash, Soil, and Soap

Abstract

Abstract. Bangladeshi communities have historically used ash and soil as handwashing agents. A structured observation study and qualitative interviews on the use of ash/soil and soap as handwashing agents were conducted in rural Bangladesh to help develop a handwashing promotion intervention. The observations were conducted among 1,000 randomly selected households from 36 districts. Fieldworkers observed people using ash/soil to wash their hand(s) on 13% of occasions after defecation and on 10% after cleaning a child's anus. This compares with 19% of people who used soap after defecation and 27% after cleaning a child who defecated. Using ash/soil or soap was rarely ( 1%) observed at other times recommended for handwashing. The qualitative study enrolled 24 households from three observation villages, where high usage of ash/soil for handwashing was detected. Most informants reported that ash/soil was used only for handwashing after fecal contact, and that ash/soil could clean hands as effectively as soap.

Effectiveness of a large‐scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh

“…Multiple factors can affect handwashing with soap: contextual (having a shared courtyard and the associated inconvenience), psychosocial (perceived value of handwashing), and technological (ease of use, handwashing station wear and tear) . In a qualitative study in rural Bangladesh, key informants stated that they purchased bar soap primarily for bathing and laundry because soap was perceived to be an expensive items that could not be used for all purposes, including handwashing, and some informants did not keep soap at the handwashing place in order to conserve soap . The practice of keeping soap away from handwashing place may not be as common in urban settings, where latrines have a place to keep soap and water .…”

“…Guided by the model and extensive formative research , the behaviour change intervention was designed to improve stable access to enabling technologies (handwashing stations and soapy water dispensers) placed conveniently in or around the home, increase handwashing skills of adults and children, build family and community support in maintaining the handwashing stations and replenishing supplies, influence community norms by modelling and supporting the behaviour in public, and provide periodic counselling and problem solving by trained community health workers. In Bangladesh, the cost of bar soap is perceived to be a barrier to frequent handwashing with soap ; a bar of soap costs 40 Taka (US $0.50) in a country where the minimum wage for a common occupation such as garment factory work is $67 per month . Soapy water is a mixture of powder detergent soap and water and is a microbiologically effective cleansing agent .…”

“…Temporal variation in the availability of water and soap in each study arm has not been described, which could allow for a better understanding of the factors associated with lack of effect of the intervention on cholera and diarrhoea hospitalisations. In addition, the presence of soap and water at a household’s primary handwashing place is an indirect method of measuring handwashing compliance that can be prone to inaccuracy . Use of additional indicators of handwashing, such as the use of water and soap during handwashing demonstration and observed handwashing behaviours using structured observation, can provide insights for handwashing outcome measurements in future programme evaluations.…”

Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions

“…Though half of the informants stated the need to wash hands with soap before preparation of some foods, such as salads and bhortas, they only recognized this as important when there was visible dirt on hands, as reported for handwashing in general in previous studies from Bangladesh 30,31 and elsewhere. 32,33 Both types of observation methods confirmed that community members did not wash hands with soap during food preparation.…”

Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study

“…Washing hands with water is common in the community from where the data for the current study was collected [24, 25]. While washing hands with soap has optimal health benefits, washing hands with water only is more beneficial than not washing hands at all [24].…”