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?

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

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

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

• Whilehand washing with water is common, mothers do not habitually hand wash withsoap – only 3.5 percent of mothers wash their hands with soap after defecatingand only 2.3 percent after wiping their child’s bottom.
• Women’sstrongest motivations for washing their hands with soap are related tonurturing children, desire for social acceptance through being perceived asclean and neat, and disgust for dirty latrines and faeces - particularly theirsmell.
• Almostevery home has soap and water for bathing and laundry. Most public latrines,where 50 percent of the population defecate, do not have facilities for handwashing with soap.
• Disgustrequires sensory cues to be instigated; feelings of contamination areparticularly pronounced after using dirty public latrines.

Basedon these findings, the study recommends the following:

• Establishing the use of soap as a normal part of the hand washing routineis crucial. Doing so at life-change events such as giving birth may be the mostsuccessful approach, as people may be more open to behaviour change.
• Handwashing facilities should be constructed outside public latrines. This mightstrengthen the social motivation as others will observe who does or doesn’t usesoap.
• Thechallenge for communications programmes is to make people feel disgusted orcontaminated if they don’t wash their hands with soap after handling faeces orbefore handling food.