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Determinants of Hand-washing with Soap: Evidence from Primary Schools in Bangladesh

Erhard, Loida Clara (2011)
Master's Thesis (101 pages)
Committee Chair / Thesis Adviser: Null, Clair
Committee Members:
Research Fields: Health Sciences, Public Health; Health Sciences, Hygiene; Health Sciences, Epidemiology
Partnering Agencies: International Non-governmental organization (e.g., CARE, Inc.)
Keywords: Hand-washing with soap; Water; Sanitation; Hygiene ; Hand Hygiene
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url:


Determinants for Hand-washing with Soap: Evidence from Primary Schools in Bangladesh

More than 8.1 million children died before their fifth birthday in 2009, mostly
from preventable and treatable causes. These child deaths are concentrated in low-income
countries, with 34% of all deaths occurring in South Asia. Although Bangladesh has made
considerable improvements in child health, many of these health problems persist. Research
studies have shown strong evidence that hand washing with soap may greatly reduce the
incidence of diarrheal disease and respiratory infection. However, there is little data on current
hygiene practices in primary schools or the state of sanitation facilities in Bangladesh.

The specific objective of the study is to better understand and measure the current
rate of hand washing with soap after latrine use in primary school children in Bangladesh.
Additionally, this study aims to determine the physical and psychological constraints that affect
students' hand washing behaviors.

Data from fifty participating schools were collected using quantitative methods.
Water, sanitation and hygiene facilities of each school were assessed with a physical survey.
Hygiene behavior after latrine use was measured by structured observations. Finally, four
students and the head master from each school were surveyed to gather information on barriers
to access of WASH facilities

Overall, the assessment of school facilities found access to water to be adequate in most
schools with 40 out of 50 schools possessing a water source on school property. Soap for hand
washing was not found to be as easily available; approximately 50% of schools had soap for
hand washing. Hand washing with soap was rarely practiced: 21% of 629 students observed
after latrine use washed both hands with soap. Survey results from students and head masters
illustrated the need for increased funding for soap and maintenance of sanitation facilities.

Inconsistent availability of soap and water are major barriers for hand washing with
soap with primary school children. Recommendations of increased funding, engagement of the
community, and continued education in school hygiene programs can help address those issues.
Further research is needed to fully understand the motivations for hand washing with soap
among primary school children in Bangladesh.

Table of Contents

Table of Contents -- Chapter 1: Introduction -- 1.1 Background...1 -- 1.2 Significance...3 -- 1.3 Study objectives...6 -- Chapter 2: Literature Review -- 2.1 School WASH Programs...7 -- 2.1.1 School WASH Hardware Components...8 -- 2.1.2 School Hygiene Education Components...10 -- 2.2 Behavior Change...15 -- 2.3 Measuring Hygiene Behaviors...17 -- 2.4 Current School WASH Programs...21 -- Chapter 3: Methods -- 3.1 Study Site & Population...25 -- 3.2 Sampling Methods...28 -- 3.3 Study Procedures...29 -- 3.4 Instrument Design...30 -- 3.5 Data Collection...31 -- 3.6 Ethics...35 -- 3.7 Data Quality Control...36 -- 3.8 Data Organization...36 -- 3.9 Data Analysis...36 -- Chapter 4: Results -- 4.1 Study Population...38 -- 4.2 Spot Check of Water Facilities...44 -- 4.3 Observed Hand-washing Behavior...45 -- 4.4 Spot Check of Latrine Facilities...50 -- 4.5 Barriers to WASH Facilities...52 -- 4.6 Motivation of School Headmaster...55 -- 4.7 Student Reported Hygiene Behaviors...57 -- 4.8 School Hygiene Program Improvement...58 -- 4.9 Program Indicators of Practicing Hand-washing...59 -- Chapter 5: Discussion -- 5.1 General Discussion of Findings...62 -- 5.2 Study Limitations...68 -- 5.3 Conclusion & Recommendations...69 -- References....77 -- Appendix...83


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