title: Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh.
abstract: We conducted a nonrandomized trial of strategies to promote soapy water for handwashing in rural Bangladesh and measured uptake. We enrolled households with children < 3 years for three progressively intensive study arms: promotion of soapy water (N= 120), soapy water promotion plus handwashing stations (N= 103), and soapy water promotion, stations plus detergent refills (N= 90); we also enrolled control households (N= 72). Our handwashing stations included tap-fitted buckets and soapy water bottles. Community promoters visited households and held community meetings to demonstrate soapy water preparation and promote handwashing at key times. Field workers measured uptake 4 months later. In-depth interviews and focus group discussions assessed factors associated with uptake. More households had soapy water at the handwashing place in progressively intensive arms: 18% (promotion), 60% (promotion plus station), and 71% (promotion, station with refills). Compared with the promotion-only arm, more households that received stations had soapy water at the primary handwashing station (44%,P≤ 0.001; 71%,P< 0.001 with station plus detergent refill). Qualitative findings highlighted several dimensions that affected use: contextual (shared courtyard), psychosocial (perceived value), and technology dimensions (ease of use, convenience). Soapy water may increase habitual handwashing by addressing barriers of cost and availability of handwashing agents near water sources. Further research should inform optimal strategies to scale-up soapy water as a handwashing agent to study health impact.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Sania
authors.initials: S
authors.lastname: Ashraf
authors.affiliation: Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Fosiul A
authors.initials: FA
authors.lastname: Nizame
authors.affiliation: Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Mahfuza
authors.initials: M
authors.lastname: Islam
authors.affiliation: Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Notan C
authors.initials: NC
authors.lastname: Dutta
authors.affiliation: Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Dalia
authors.initials: D
authors.lastname: Yeasmin
authors.affiliation: Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Sadika
authors.initials: S
authors.lastname: Akhter
authors.affiliation: Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Jaynal
authors.initials: J
authors.lastname: Abedin
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.affiliation: Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.
authors.forename: Pavani K
authors.initials: PK
authors.lastname: Ram
authors.affiliation: Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Leanne
authors.initials: L
authors.lastname: Unicomb
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Elli
authors.initials: E
authors.lastname: Leontsini
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000328:Adult; D001459:Bangladesh; D005260:Female; D006235:Hand Disinfection / Q000379:methods*; D063373:Hand Hygiene / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012915:Soaps
chemical_list: D012915:Soaps