Better hygiene:  washing hands with soap in Ghana

Washing hands with soap is a simple and effective way to prevent the spread of many infectious diseases. Yet globally, hand washing rates are low. What factors affect hand washing behaviour in Ghana and what could motivate hygiene behaviour change?

One of the main Millennium Development Goals is to achieve a sixty-six percent drop in mortality rates in children under five years old by 2015. Each year over two million children die globally from diarrhoeal diseases, and a further two million die from acute respiratory infections. Many of these infections could be prevented by hygienic hand washing.

Rates of hand washing with or without soap are universally low across Ghana, and Ghanaians experience around nine million episodes of diarrhoea annually; about 84,000 children die from diarrhoea each year. Worldwide, rates of hand washing are also unacceptably low, yet to date increasing knowledge through health education has had only a limited impact on behaviour.

A study by the London School of Hygiene and Tropical Medicine proposes that consumer marketing, which aims to target the audiences’ hopes, desires and motivations, may be a more effective approach than increasing knowledge via health education. The study used consumer research to identify what factors influence hand washing with soap. It found that:

• While hand washing with water is common, mothers do not habitually hand wash with soap – only 3.5 percent of mothers wash their hands with soap after defecating and only 2.3 percent after wiping their child’s bottom.
• Women’s strongest motivations for washing their hands with soap are related to nurturing children, desire for social acceptance through being perceived as clean and neat, and disgust for dirty latrines and faeces - particularly their smell.
• Almost every home has soap and water for bathing and laundry. Most public latrines, where 50 percent of the population defecate, do not have facilities for hand washing with soap.
• Disgust requires sensory cues to be instigated; feelings of contamination are particularly pronounced after using dirty public latrines.

Based on these findings, the study recommends the following:

• Establishing the use of soap as a normal part of the hand washing routine is crucial. Doing so at life-change events such as giving birth may be the most successful approach, as people may be more open to behaviour change.
• Hand washing facilities should be constructed outside public latrines. This might strengthen the social motivation as others will observe who does or doesn’t use soap.
• The challenge for communications programmes is to make people feel disgusted or contaminated if they don’t wash their hands with soap after handling faeces or before handling food.

Source(s):
‘Health in Our Hands, But Not in Our Heads: Understanding Hygiene Motivation in Ghana’, Health Policy and Planning 22, pages 225-233, Oxford University Press and The London School of Hygiene and Tropical Medicine, by Beth Scott, Val Curtis, Tamer Rabie and Nana Gargrah-Aidoo, 2007

id21 Research Highlight: 19 December 2007

Further Information:
Beth Scott
The Hygiene Centre
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
United Kingdom

Tel: +44 (0)20 7927 2398
Fax: +44 (0)20 7636 7843
Contact the contributor: beth.scott@lshtm.ac.uk

London School of Hygiene and Tropical Medicine (LSHTM), UK

Other related links:
'Poor hygiene and diarrhoea: reducing the risk in the Kyrgyz Republic'

'Changes in hygiene behaviour: do they persist?'

'Zimbabwe’s community health clubs create demand for better hygiene and sanitation'

'Water, sanitation and hygiene: primary concerns for public health'

'Hygiene promotion: evidence of efficiency and affordability from Burkina Faso'