title: Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya.
abstract: OBJECTIVE
  To further the understanding of sanitation and hygiene in long-term camp populations.
  
  
  METHODS
  Data were collected by structured observation of handwashing (126 households), a questionnaire on sanitation, hygiene and household characteristics (1089 households) and discussions with mothers. Random walk algorithms were used to select households for observation and survey. Respondents for qualitative methods were a convenience sample.
  
  
  RESULTS
  Across all key handwash occasions [excluding events with no handwash (n=275)], soap was used for 30% of handwashes. After latrine use, both hands were washed with soap on 20% of occasions observed. Availability of soap in households differed across sites and mirrored the extent to which it was distributed free of charge. Qualitative data suggested lack of free soap as a barrier to 'safe' handwashing. Laundry was the priority for soap. In Ethiopia and Kenya, open defecation was practised by a significant minority and was more prevalent amongst households of rural origin. In Ethiopia, open defecation was significantly more prevalent amongst women.
  
  
  CONCLUSIONS
  Despite continuing hygiene education, rates of 'safe' handwashing are sub-optimal. Soap scarcity in some households and the prioritisation of laundry are barriers to safe practice. Heterogeneity with respect to education and place of origin may need to be taken into account in the design of improved interventions.
authors: London School of Hygiene and Tropical Medicine, London, UK. adam.biran@lshtm.ac.uk
authors: Adam
authors: A
authors: Biran
authors: Wolf-Peter
authors: WP
authors: Schmidt
authors: Lemlem
authors: L
authors: Zeleke
authors: Haron
authors: H
authors: Emukule
authors: Hla
authors: H
authors: Khay
authors: Julian
authors: J
authors: Parker
authors: Dorothy
authors: D
authors: Peprah
mesh_terms: D000293:Adolescent; D000328:Adult; D005002:Ethiopia; D005191:Family Characteristics; D005260:Female; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D006920:Hygiene; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009035:Mothers; D012036:Refugees / Q000706:statistics & numerical data*; D012307:Risk Factors; D012915:Soaps; D013785:Thailand; D014038:Toilet Facilities / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D012915:Soaps