Clean Hands Save Lives, Save Cost

The Global Handwashing enlightenment campaign aimed at increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases catches my attention today.  Towards the campaign aim, around the world, children, teachers, parents, celebrities, and health officials are utilized to mobilize and motivate millions to wash their hands with soap always in order to reduce life-threatening diseases, such as diarrhea and acute respiratory infections.

It is known that children suffer disproportionately from diarrheal diseases, with more than 3.5 million children under five dying every year from diarrhea and pneumonia-related diseases. On the other hand, it is estimated that the simple act of washing hands with soap can reduce the incidence of diarrheal rates among children under five by almost 50 per cent, and respiratory infections by nearly 25 percent.
Hence, the slogan “Clean hands save lives” drives the campaign message home, the message is expected to be clearly carried home to children and schools in particular. This is because children acting as agents of change take the good practices of hygiene learned at school back into their homes and communities. The active participation and involvement of children, along with culturally sensitive community-based interventions aim at ensuring sustained behavioral change.

Handwashing with soap - particularly at critical moments, including after using the toilet and before handling food – is a key cost effective and life-saving intervention. Research in several developing countries illustrates that lack of soap is usually not the barrier; rather, the problem is that soap is not routinely used for handwashing. As an example, for most people, it is a known fact that many hardly washed their hands with soap after cleaning a child after defecation or when commencing feed from hand to mouth

Children as campaign driver
It has been extrapolated from statistical reports that of the approximately 120 million children born in the developing world each year, half will live in households without access to improved sanitation, at grave risk to their survival and development. Poor hygiene and lack of access to sanitation and portable water together contribute to about 88% of deaths from diarrheal diseases, accounting for 1.5 million diarrhea-related under-five deaths each year.

The recurrent Nigerian story on cholera-related deaths further tells the story the hard way. Children suffer disproportionately from diarrheal, respiratory diseases and deaths. But researches have shown repeatedly that, children – the segment of society so often the most energetic, enthusiastic, and open to new ideas – can also be powerful agents of behavioral change. Here lies the sense in this campaign to effect the global attitudinal change with children as agent-catalysts.

Health personnel are ‘culpable’
Surprisingly, even medical and other health personnel who should know better are noted ‘culprits of wrong attitude to handwashing. A study of doctors’ handwashing practices in one of the Lagos-based Teaching Hospitals, as revealed in a research presentation at the July 2010 Conference of the Society for Quality Healthcare in Nigeria (SQHN), showed that many doctors failed to wash their hands with soap between patient visits at an alarming frequency. If this is noted to be the practice in a teaching hospital where the best in vogue is the expected norm, then one can think of the worst practice in hospitals of lower levels.

Reasons adduced for this unpalatable behavior by medical personnel, who ordinarily fully understand the health benefits of handwashing with soap, are lack of time, no rough paper towels for drying, inconveniently located sinks, and hands chapped by frequent washing with drying soaps. Moreover, many hospitals still provide bar soap for handwashing, which many health practitioners are aware of its potential to culture microbes. Here, it should be noted that liquid soaps are far preferable to bar soaps for handwashing, especially in situations which involve multiple-users.

Changing people’s handwashing habit
A good approach to appropriate handwashing behavior acquisition is to study and know what really works, and what doesn’t, in changing private, personal behaviors and habits. It need be noted that what doesn’t work is top-down, technology-led solutions or campaigns that hinge mainly on health education messages.

What is more effective is using approaches that build on the lessons of social marketing. This new approach emphasizes the role of careful formative research, which relates to a thorough study of the interests, attributes, needs and motivations of different people within a community. It is also based on the recognition that one size does not fit all and evidence showing that promoting a single message is more effective than promoting multiple messages. A good example here is the ‘Dettol’ repeated campaign slogan of “If you don’t care, who will?” which is one of such messages in vogue.  

In the same vein, approaches that create incentives for positive provider attitudes and behaviors get better results than those that rely on targets and punitive management practices. For an example, successful sanitation programs generate community demand for toilets and latrines by appealing to people’s desires for status, acceptance, community solidarity, privacy, convenience, safety and comfort since appeals to health tend to be significantly less effective in motivating behavioral change. The non-health motivations can be compared to the reasons people try to lose weight; maintaining a healthy weight is very important to one’s health – but the reason people go on diets is generally not to be healthier but rather to look better.

The prime logic of today’s discussion appropriate and routine handwashing everyone can contribute to promoting handwashing with soap! Join the crusade today and remain in it always by promoting routine handwashing with soaps at home, schools, offices and in the larger community.