Water Currents: Global Handwashing Day 2019

Children in Kuach, South Sudan, learn how to wash their hands properly. USAID and its partners help communities learn about essential hygiene and health behavior to prevent diseases like cholera and diarrhea. Photo credit: UNICEF/Kate Holt.

October 15, 2019, is Global Handwashing Day (GH Day), an annual advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap. This year’s theme is “Clean Hands for All,” which gives much needed attention to the marginalized groups that lack access to handwashing facilities or face discrimination in the provision of handwashing and other water, sanitation, and hygiene (WASH) services.

The theme aligns with USAID’s Water and Development Plan under the 2017 U.S. Government Global Water Strategy, which has the stated result of increasing the practice of key hygiene behaviors including handwashing with soap among the underserved and most vulnerable populations.

This issue contains recent research and studies about handwashing programs and services for people with disabilities, refugees, patients in health care facilities, schoolchildren, and the urban poor.


Global Handwashing Day, October 15, 2019 – Inequalities in handwashing facilities and lack of effective handwashing promotion programs can put individuals at higher risk for diseases that impact their health, education, and economic outcomes. GH Day 2019—with its theme of social inclusion—follows the global push to leave no one behind in the Sustainable Development Agenda. The Global Handwashing Partnership (GHP) organizes this annual event.

Handwashing with Soap after Potential Faecal Contact: Global, Regional and Country Estimates. International Journal of Epidemiology, December 2018. People with access to designated handwashing facilities are about twice as likely to wash their hands with soap after potential fecal contact as people who lack a facility. Still, even among those with access, handwashing with soap is poorly practiced.

People with Disabilities
Mainstreaming Disability and Making WASH Programmes Inclusive. Institute of Development Studies, October 2018. Designing inclusive WASH facilities from the start is the most cost-effective approach. Nonetheless, the cost of retrofitting existing facilities is less than some might expect.

Disability and Development Report: Realizing the Sustainable Development Goals by, for and with Persons with Disabilities. United Nations, 2019. Households, as well as governments, can implement low-cost, inclusive adaptations and universal design solutions to facilities, including toilets, water points, water carriers, bathing places, and handwashing facilities.

Patients in Health Care Facilities
Interventions to Improve Water Supply and Quality, Sanitation and Handwashing Facilities in Healthcare Facilities, and Their Effect on Healthcare-Associated Infections in Low-Income and Middle-Income CountriesBMJ Global Health, July 2019. The authors of this review concluded that there is a dearth of evidence for the effect of WASH in healthcare facilities and that additional and higher quality research is needed to understand the impact of different WASH interventions on infections associated with these facilities. Filling this gap can help prioritize the most effective approaches in these often resource-poor settings.

Safe Water and Hygiene Integration with Human Immunodeficiency Virus and Antenatal Services: Leveraging Opportunities for Public Health Interventions and Improved Service Uptake. American Society of Tropical Medicine and Hygiene, March 2018. This evaluation suggests that provision of hygiene kits, refills of supplies on subsequent visits, and HIV testing during antenatal clinic visits is feasible and may help improve household hygiene and increase the use of health services.

Barriers and Opportunities Experienced by Staff when Implementing Infection Prevention and Control Guidelines During Labour and Delivery in Healthcare Facilities in Nigeria. Journal of Hospital Infection, August 2019. Safe childbirth and postnatal care require comprehensive adherence to hand hygiene protocols and the use of disposable personal protective equipment.

Diffusion of Handwashing Knowledge and Water Treatment Practices from Mothers in an Antenatal Hygiene Promotion Program to Nonpregnant Friends and Relatives, Machinga District, Malawi. International Quarterly of Community Health Education, September 2018. Qualitative data from in-depth interviews suggest that program participants helped motivate adoption of water treatment and hygiene behaviors among friends and relatives.

Preventing Neonatal Sepsis in Rural Uganda: A Cross-Over Study Comparing the Tolerance and Acceptability of Three Alcohol-Based Hand Rub Formulations. BMC Public Health, November 2018. Mothers of newborn children in eastern Uganda participated in a test of three alcohol-based hand rub (ABHR) formulations for preventing neonatal infection. All three had high overall satisfaction scores, but participants scored the ABHR with added perfume the highest and used it much more often than plain ABHR.

Low-Income Urban Populations
Effects of Complexity of Handwashing Instructions on Handwashing Procedure Replication in Low-Income Urban Slums in Bangladesh: A Randomized Non-Inferiority Field Trial. Journal of Water, Sanitation and Hygiene for Development, June 2019. Handwashing instructions vary in complexity, with some recommending multiple steps. Simple handwashing steps are easier to remember in the long term compared to complex steps.

Acceptability and Feasibility of Sharing a Soapy Water System for Handwashing in a Low-Income Urban Community in Dhaka, Bangladesh: A Qualitative Study. American Society of Tropical Medicine and Hygiene, August 2018. The soapy water system evaluated in this study was simple in design, cost-effective, replicable, popular with intervention recipients and neighboring nonrecipients, and commonly shared among nonrelated households, suggesting a potential for scalability.

Refugees/Humanitarian Situations
Rapid Review of Disability and Older Age Inclusion in Humanitarian WASH Interventions. Humanitarian Innovation Fund, May 2019. People with disabilities and the elderly are disproportionately affected by and at greater risk because of their lack of access to water and sanitation during humanitarian response situations.

Could the Supertowel Be Used as an Alternative Hand Cleaning Product for Emergencies? An Acceptability and Feasibility Study in a Refugee Camp in Ethiopia. PLoS One, May 2019. Researchers found the Supertowel to be an acceptable and useful hand-cleaning product that could complement soap use in crisis contexts.

Child's Play: Harnessing Play and Curiosity Motives to Improve Child Handwashing in a Humanitarian Setting. International Journal of Hygiene and Environmental Health, September 2018. Distributing soaps with toys embedded inside, in a rapidly deployable intervention, can improve child handwashing behavior during humanitarian emergencies.

Assessing Emotional Motivators for Handwashing with Soap in Emergencies: Results from Three Asian Countries. Waterlines, January 2019. This paper examines how emotional motivators can help promote handwashing with soap among mothers affected by an emergency.

A Disruptive Cue Improves Handwashing in School Children in Zambia. Health Promotion International, October 2018. The intervention tested in this study saw a greater increase in the likelihood of soap use in intervention schools than in control schools, though both intervention and control schools saw an increase in handwashing without soap. This low-cost intervention could be scaled throughout Zambia and may work well in other countries of similar circumstances.

Effect of a School-Based Hygiene Behavior Change Campaign on Handwashing with Soap in Bihar, India: Cluster-Randomized Trial. American Journal of Tropical Medicine and Hygiene, August 2018. The authors found no evidence for a health-relevant effect of the “School of 5” intervention on handwashing with soap in schoolchildren and their mothers, possibly due to low campaign intensity, ineffective delivery, and a model not well tailored to these challenging physical and social environments.

Handwashing Research
January to June 2019 Handwashing Research Index. GHP, June 2019. Between January and June 2019, GHP found 36 studies that explore handwashing in connection with diverse programmatic areas in global health and development.

2018 Handwashing Research Index. GHP, March 2019. In 2018, GHP found 155 studies that explore handwashing in connection with a range of areas in global health and development, varying from urban design to maternal and child health.

The State of Handwashing in 2017: Annual Research Summary. GHP, May 2018. In this summary, GHP outlines key themes and findings from 117 handwashing-related research papers published in 2017.

Other Studies
Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi. American Journal of Tropical Medicine and Hygiene, June 2019. This study found that presence of a handwashing facility and locally made dish rack and psychosocial factors (attitude, norms, ability, self-regulation) were strong predictors of success of interventions emphasizing key behaviors to improve food hygiene.

Toolkit: Understanding and Addressing Equality, Non-Discrimination and Inclusion in Water, Sanitation and Hygiene (WASH) Work. WaterAid, 2018. This resource provides practical guidance and support on reducing inequalities commonly found in WASH programs and advocacy work.

Global Handwashing Partnership – GHP is a coalition of international stakeholders working to promote handwashing with soap and recognize hygiene as a pillar of international development and public health.