Handwashing in 51 Countries: Analysis of Proxy Measures of Handwashing Behavior in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 2010-2013.

Swapna Kumar,Fred Arnold,Pavani K Ram,Rolf Luyendijk,Merri Weinger,Libbet Loughnan,Orlando Hernandez

doi:10.4269/ajtmh.16-0445

Abstract

.In 2009, a common set of questions addressing handwashing behavior was introduced into nationally representative Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), providing large amounts of comparable data from numerous countries worldwide. The objective of this analysis is to describe global handwashing patterns using two proxy indicators for handwashing behavior from 51 DHS and MICS surveys conducted in 2010–2013: availability of soap anywhere in the dwelling and access to a handwashing place with soap and water. Data were also examined across geographic regions, wealth quintiles, and rural versus urban settings. We found large disparities for both indicators across regions, and even among countries within the same World Health Organization region. Within countries, households in lower wealth quintiles and in rural areas were less likely to have soap anywhere in the dwelling and at designated handwashing locations than households in higher wealth quintiles and urban areas. In addition, disparities existed among various geographic regions within countries. This analysis demonstrates the need to promote access to handwashing materials and placement at handwashing locations in the dwelling, particularly in poorer, rural areas where children are more vulnerable to handwashing-preventable syndromes such as pneumonia and diarrhea.

Highlights

Pneumonia and diarrheal disease are leading causes of postneonatal child mortality, accounting for approximately 1.6 million child deaths worldwide in 2013.1,2 Even as mortality due to both diseases has been declining, morbidity remains high, with an estimated 1.7 billion episodes of diarrhea and 120 million episodes of pneumonia among children less than 5 years old in 2010.3 These illnesses lead to preventable mortality and to health-care seeking, financial costs for families, and lost caloric intake for children
In 2009, a common set of questions addressing handwashing behavior was introduced into nationally representative Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), providing large amounts of comparable data from numerous countries worldwide
We describe handwashing across geographic regions, wealth quintiles, and rural and urban settings

Summary

Introduction

Pneumonia and diarrheal disease are leading causes of postneonatal child mortality, accounting for approximately 1.6 million child deaths worldwide in 2013.1,2 Even as mortality due to both diseases has been declining, morbidity remains high, with an estimated 1.7 billion episodes of diarrhea and 120 million episodes of pneumonia among children less than 5 years old in 2010.3 These illnesses lead to preventable mortality and to health-care seeking, financial costs for families, and lost caloric intake for children. Though studies of household handwashing behavior have been conducted sporadically worldwide, there has been no systematic method of data collection to allow for comparison of handwashing behavior across regions, and identification of national and subnational populations where child mortality and morbidity remain high and where particular need exists with respect to handwashing promotion.[15] Without meaningful and globally comparable data, it is difficult for governments and international organizations to prioritize handwashing as a public health tool. With the introduction of a KUMAR AND OTHERS standard set of handwashing questions in the MICS and DHS core questionnaires, we have for the first time a large set of comparable data on handwashing from numerous countries Routine reporting from both survey networks includes disaggregation of data by potential sources of disparity and geographic regions within countries, allowing novel insight into differences affecting handwashing behavior and revealing potential targets for intensive handwashing promotion. We describe handwashing across geographic regions, wealth quintiles, and rural and urban settings

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Discussion

Conclusion