title: Is pregnancy a teachable moment to promote handwashing with soap among primiparous women in rural Bangladesh? Follow-up of a randomised controlled trial.
abstract: Promoting handwashing with soap to mothers of young children can significantly reduce diarrhoea and pneumonia morbidity among children, but studies that measured long-term behaviour after interventions rarely found improvements in handwashing habits. Expecting mothers may experience emotional and social changes that create a unique environment that may encourage adoption of improved handwashing habits. The objective of this study was to determine whether exposure to an intensive handwashing intervention in the perinatal period (perinatal arm) was associated with improved maternal handwashing behaviour vs. exposure to the same intervention after the end of the perinatal period (post-neonatal arm).
  
  
  
  We identified primiparous women previously enrolled a randomised controlled handwashing intervention trial (November 2010-December 2011) and observed handwashing behaviours at the home 1-14 months after completion of the RCT (January-May 2012). We observed maternal handwashing and estimated the prevalence ratio (PR) of maternal handwashing using log-binomial regression.
  
  
  
  We enrolled 107 mothers in the perinatal arm and 105 mothers in the post-neonatal arm. Handwashing with soap at recommended times was low overall (4.6%) and comparable between arms (PR = 0.9, 95% CI 0.5, 1.5).
  
  
  
  This handwashing intervention was unable to develop and establish improved handwashing practices in primiparous women in rural Bangladesh. While pregnancy may present an opportunity and motivation to do so, further studies should assess whether social, individual and environmental influences overcome this motivation and prevent handwashing with soap among new mothers.
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA.
authors.forename: Kelly B
authors.initials: KB
authors.lastname: Kamm
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA.
authors.forename: Jelena
authors.initials: J
authors.lastname: Vujcic
authors.affiliation: Health Systems & Infectious Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Sharifa
authors.initials: S
authors.lastname: Nasreen
authors.affiliation: Woods Institute of the Environment, Stanford University, Stanford, CA, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.affiliation: Public Health Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: K
authors.initials: K
authors.lastname: Zaman
authors.affiliation: Public Health Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA.
authors.forename: Pavani K
authors.initials: PK
authors.lastname: Ram
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006235:Hand Disinfection / Q000379:methods; D006266:Health Education; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services; D009042:Motivation; D010298:Parity; D018743:Perinatal Care; D011014:Pneumonia / Q000517:prevention & control; D011247:Pregnancy; D012424:Rural Population; D012915:Soaps; D055815:Young Adult
chemical_list: D012915:Soaps
keywords: Bangladesh; embarazo; grossesse; handwashing; lavado de manos; lavage des mains; pregnancy