Water Currents: Handwashing Research

Water Currents is produced biweekly by USAID’s E3 Water Office. Each issue contains recent news and articles on water sector issues, partner and donor updates, latest sector research, and a special focus on one topic. Please provide your feedback and suggestions by contacting the waterteam@usaid.gov.

Highlighting the most recent handwashing research, this issue of Currents includes literature reviews by the Global Handwashing Partnership, the International Initiative for Impact Evaluation, and an interesting report on handwashing and rational addiction. Articles discuss handwashing research in Bangladesh, Tanzania, and Zimbabwe as well as studies on handwashing and infectious diseases, among other topics.


Water Currents - In Focus


The State of Handwashing in 2016: Annual ReviewGlobal Handwashing Partnership (GHP), March 2017. This GHP review summarizes key themes and findings from 59 peer-reviewed handwashing-related research papers published in 2016.

Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed-Method Systematic ReviewInternational Initiative for Impact Evaluation, June 2017. The purpose of this review was to learn which factors might change handwashing and sanitation behavior, finding that a combination of different promotional elements may be the most effective strategy.

Habit Formation and Rational Addiction: A Field Experiment in HandwashingYale University, Economic Growth Center, December 2016. The researchers in this study designed and implemented an experiment to test predictions of the rational addiction model in the context of handwashing. The findings are presented in a video from a 2016 conference.

Peer-Reviewed Articles

Identifying Behavioural Determinants for Interventions to Increase Handwashing Practices Among Primary School Children in Rural Burundi and Urban ZimbabweBMC Research Notes, July 2017. This article presents the results of a school handwashing program in two countries that applied the RANAS (risk, attitudes, norms, ability, and self-regulation) systematic approach to behavior change.

Handwashing in 51 Countries: Analysis of Proxy Measures of Handwashing Behavior in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 2010–2013American Journal of Tropical Medicine and Hygiene, June 2017.  The findings of this survey analysis on global handwashing behavior demonstrate that the placement of handwashing stations in a dwelling— not just access to handwashing materials—is important to changing handwashing behavior.

Unpacking the Enabling Factors for Hand, Cord and Birth-Surface Hygiene in Zanzibar Maternity UnitsHealth Policy and Planning, June 2017. A study of maternity units in Zanzibar, finds a lack of essential infection prevention practices like knowledge and training, and infrastructure requirements to enable clean hands, such as constant running water.

Understanding the Challenges of Improving Sanitation and Hygiene Outcomes in a Community Based Intervention: A Cross-Sectional Study in Rural TanzaniaInternational Journal of Environmental Research and Public Health, June 2017. In rural Tanzania, researchers studied how factors such as water storage and usage, safe excreta disposal, and other hygiene practices—not just the availability of water alone—are critical for interventions to prevent the spread of waterborne diseases.

A Method to Test the Efficacy of Handwashing for the Removal of Emerging Infectious PathogensJournal of Visualized Experiments, June 2017. The authors of this paper describe a laboratory method to assess the efficacy of handwashing for removing micro-organisms from hands and their persistence in rinse water. The method fills research gaps on handwashing efficacy.

Provision Versus Promotion to Develop a Handwashing Station: The Effect on Desired Handwashing BehaviorBMC Public Health, May 2017. Diarrhea in children tends to increases when they start eating solid foods, possibly due to poor hand hygiene by the caregiver during food preparation. This three-month pilot intervention helped households set up handwashing stations and tested the feasibility of integrating this intervention with a child feeding program. 

Behavioral Antecedents for Handwashing in a Low-Income Urban Setting in Bangladesh: An Exploratory StudyBMC Public Health, May 2017. This study states that the rate of handwashing with soap is influenced by a broader range of factors, many unrelated to fecal contamination, that indicate to people when and where to wash their hands. This study attempts to create a comprehensive list of these factors. 

Does Targeting Children with Hygiene Promotion Messages Work? The Effect of Handwashing Promotion Targeted at Children, on Diarrhoea, Soil-Transmitted Helminth Infections and Behaviour Change.Tropical Medicine International Health, May 2017. This literature review of handwashing interventions targeting children found only limited research and a lack of sufficient evidence to determine the most effective means to increase handwashing with soap among children.

Impact of an Intensive Perinatal Handwashing Promotion Intervention on Maternal Handwashing Behavior in the Neonatal PeriodHindawi BioMed Research International, April 2017. Researchers examined the impact of intensive handwashing promotion on handwashing behavior of mothers of neonates. They found that intensive promotion resulted in increased availability of soap and water at handwashing places, but only a modest increase in maternal handwashing with soap.

Hand Hygiene Intervention Strategies to Reduce Diarrhoea and Respiratory Infections among Schoolchildren in Developing Countries: A Systematic Review. International Journal Environmental Research and Public Health, April 2017. The objective of this review was to identify hand hygiene intervention strategies to reduce infectious diseases such as diarrhea and respiratory tract infections among schoolchildren. The review adds to the existing evidence that multi-level handwashing interventions can reduce the incidence of diarrhea, respiratory infections, and school absenteeism.

Handwashing and Ebola Virus Disease Outbreaks: A Randomized Comparison of Soap, Hand Sanitizer, and 0.05% Chlorine SolutionsPLoS One, February 2017. The authors in this study evaluated six handwashing protocols for efficacy of handwashing on nonpathogenic model organisms and persistence of organisms in rinse water. It was found that chlorine-based methods may offer a benefit of reducing persistence in rinse water.

Contextual and Psychosocial Determinants of Effective Handwashing Technique: Recommendations for Interventions from a Case Study in Harare, ZimbabweAmerican Journal of Tropical Medicine and Hygiene, February 2017. This case study identifies behavioral determinants of effective handwashing, which include knowledge of how to wash hands effectively, availability of a handwashing station with functioning water tap, and self-reported frequency of handwashing.

Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural BangladeshAmerican Journal of Tropical Medicine and Hygiene, February 2017. This trial finds that soapy water may increase habitual handwashing by addressing barriers of cost and availability of handwashing agents near water sources. It recommends further research on ways to scale-up soapy water as a handwashing agent to study health impact.

Exploring the Link Between Handwashing Proxy Measures and Child Diarrhea in 25 Countries in Sub-Saharan Africa: A Cross-Sectional StudyJournal of Water, Sanitation and Hygiene for Development, March 2017. This study examined the link between handwashing measures and child diarrhea, finding that the availability of handwashing resources is important for preventing child diarrhea, as are handwashing promotion programs, which should be tailored to the unique context of each country.

Participatory Science and Innovation for Improved Sanitation and Hygiene: Evaluation of Project SHINE, a School-Based Intervention in Rural TanzaniaBMC Public Health, February 2017. An evaluation of the Project SHINE model shows its promise as an innovative capacity-building approach and as an engagement and empowerment strategy for youth and communities to improve sanitation and hygiene.

Costs of Diarrhoea and Acute Respiratory Infection Attributable to Not Handwashing: The Cases of India and ChinaTropical Medicine and International Health, January 2017. The objective of this study was to estimate the national costs relating to diarrhea and acute respiratory infections from not handwashing with soap and the costs and benefits of handwashing behavior change programs in India and China.

Handwashing, But How? Microbial Effectiveness of Existing Handwashing Practices in High-Density Suburbs of Harare, ZimbabweAmerican Journal of Infection Control, March 2017. The authors of this study sought to determine how the handwashing technique of case study participants influences handwashing effectiveness, concluding that handwashing campaigns should also focus on technique.


Water Currents - In the News

Women Still Carry Most of the World’s WaterThe Conversation, July 2017. An insufficient supply of safe and accessible water poses extra risks and challenges for women and girls. Without recognizing the uneven burden that women bear, programs to bring water to places in need will continue to fail to meet their goals.

SOAPEN: This Soap Crayon Can Help Prevent 1.5 Million Child Deaths Each YearInterAksyon Lifestyle, July 2017. A group of Indian industrial designers in New York City have created SOAPEN, a colored marker with ink that turns into soapy water.

You Probably Don't Want To Know About Haiti's Sewage ProblemsNational Public Radio: Goats and Water, July 2017. Port-au-Prince, Haiti, is one of the largest cities in the world without a central sewage system. There are no sewers connecting wastewater from sinks, showers, and toilets to treatment plants, and much of that waste ends up in canals and other dumping grounds where it can contaminate drinking water and spread disease.

Water Works: How a Simple Technology in Dhaka Is Changing the Way People Get Clean WaterWater Blog, July 2017. This article describes a novel treatment product that automatically dispenses small amounts of chlorine to create safe drinking water. Researchers installed dispensers at strategic water points that typically serve anywhere from 10 to 100 families.

If you would like to feature your organization's materials or suggest other content for upcoming issues of Water Currents, please send them to Dan Campbell, Knowledge Creation/WASH Specialist, at dcampbell@waterckm.com.


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