title: A pilot study of a portable hand washing station for recently displaced refugees during an acute emergency in Benishangul-Gumuz Regional State, Ethiopia.
abstract: BACKGROUND
  Diarrheal disease is a common cause of morbidity and mortality. Displaced populations are especially vulnerable due to overcrowded camps and limited access to water and sanitation facilities, increasing the risk for outbreaks. Hand washing with soap is effective against disease transmission, and studies suggest access to a convenient hand washing station may be the key to increasing hand washing behavior. This pilot study evaluated the acceptability, durability and use of a novel hand washing bag (HWB) at the household level among Sudanese refugees immediately following an acute emergency.
  
  
  METHODS
  We distributed one HWB to every household (n = 874) in Adamazin Transit Center in western Ethiopia. The evaluation consisted of baseline and endline surveys, three monthly monitoring visits and focus group discussions (FGDs) over a six month period. FGD data were analyzed using the Risk, Attitudes, Norms, Abilities, and Self-Regulatory model. Survey and monitoring data were analyzed using SPSS. Note: Residents were resettled to Bambasi Refugee Camp during the study period where the endline survey was conducted.
  
  
  RESULTS
  Baseline data suggested water quantity and availability of soap were below SPHERE standards, however participants responded positively to the HWB. At the end of the monitoring period, 73.9 % of the same households retained their original HWBs and 66.7 % of bags had water at the time of the visit. The mean lifespan of the HWB during the monitoring period was 2.73 months. From a new sample of households selected for the endline evaluation, 93.0 % had an original HWB, but only 39.4 % had water in the bag. Endline FGD participants felt the HWB was useful, but reported insufficient soap and hygiene messaging.
  
  
  CONCLUSIONS
  The HWB performed well during the early phases of the emergency, however longer term results in this setting are unclear. The low levels of reported use measured by proxy indicators at six months indicated decreasing acceptability over time or a reflection of potential differences between the two sites. It is also unknown whether the HWB influenced hand washing behavior. Study findings were shared with the manufacturer in an effort to improve the bag's acceptability, utility, and durability.
authors: Emergency Response and Recovery Branch, Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-22, Atlanta, GA 30329 USA.
authors: Farah
authors: F
authors: Husain
authors: Emergency Response and Recovery Branch, Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-22, Atlanta, GA 30329 USA.
authors: Colleen
authors: C
authors: Hardy
authors: International Rescue Committee, T.K. International P.L.C, Bole Sub-city, Kebele 03/05, House # 162, Addis Ababa, Ethiopia.
authors: Lemlem
authors: L
authors: Zekele
authors: International Rescue Committee, T.K. International P.L.C, Bole Sub-city, Kebele 03/05, House # 162, Addis Ababa, Ethiopia.
authors: David
authors: D
authors: Clatworthy
authors: Emergency Response and Recovery Branch, Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-22, Atlanta, GA 30329 USA.
authors: Curtis
authors: C
authors: Blanton
authors: Emergency Response and Recovery Branch, Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-22, Atlanta, GA 30329 USA.
authors: Thomas
authors: T
authors: Handzel
keywords: Ethiopia; Hand washing; Humanitarian emergencies; Refugees; WASH