Abstract

Background: Handwashing with soap can disrupt the transmission of diarrhea-causing pathogens, a major cause of morbidity in emergency settings. However, evidence that traditional hygiene promotion activities drive sustained increases in handwashing is weak. We aimed to test: 1) an improved handwashing station and whether it increased handwashing and 2) if pairing improved stations with a behavioral intervention based on emotional drivers further increased handwashing.

Methods: We conducted a three-arm clustered randomized controlled trial in Nduta refugee camp, Tanzania, enrolling all households in each intervention arm using systematic sampling. One arm was given access to the Promotion and Practice Handwashing Kit (PPHWK), a kit designed by Oxfam and partners. The second arm had access to the PPHWK and a behavioral intervention-Mum’s Magic Hands (MMH), a handwashing promotion strategy based on emotive drivers, with mothers and female carers as primary target group. The third arm was the control group. Baseline and endline data were collected using surveys, focus group discussions (FGDs), structured and qualitative observations.

Results: At endline, all intervention households were more likely to note the importance of handwashing. In structured observations, persons from PPHWK+MMH households practiced handwashing more consistently 94.3%, compared with 78.0% in PPHWK only and 69.6% in control. PPHWK+MMH households self-reported significantly lower rates of diarrhea at endline than baseline p = 0.025. FGD participants preferred the PPHWK over alternative handwashing stations (tippy taps), citing good design, durability, and ease of use. All participants exposed to MMH considered it effective, with a reported increase in handwashing with soap, particularly among children.

Conclusion: We found substantial improvements in both reported and observed handwashing with soap associated with PPHWK access, especially when paired with MMH. Pairing an improved handwashing station with innovative promotion strategies may significantly improve handwashing and subsequently reduce morbidity among refugee populations. Feedback on the PPHWK and MMH were used to develop a new PPHWK prototype and improve on MMH approach of targeting mothers and other household members.

Keywords: Emergency Contexts; Emotional Drivers; Environmental Cues; Handwashing Stations; Handwashing with Soap; WASH; Refugee Camp; Tanzania; Mothers in Refugee Context

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Citation

Citation: Foyeke Tolani., et al. “Improving Handwashing Promotion and Practice in Emergency Contexts: Evaluating Two Novel Approaches in Nduta Camp, Tanzania". Acta Scientific Women's Health 2.11 (2020): 25-36.

Copyright

Copyright: © 2020 Foyeke Tolani., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.