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Title: Measuring hand washing behaviour in low income settings : methodological and validity issues
Author: Danquah, Lisa Odoso
ISNI:       0000 0004 2703 3822
Awarding Body: University of Southampton
Current Institution: University of Southampton
Date of Award: 2010
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Significant global health attention and promotion has been focused on hand washing with soap due to the clear benefits observed in promoting and ensuring child health. However, the measurement and evaluation of hand washing behaviours remains complex. The Sanitation, Hygiene Education and Water Supply in Bangladesh Programme (SHEWA-B) is a large project being implemented by the Government of Bangladesh and UNICEF. This research assessed methodological issues of measuring hand washing behaviours through comparison of structured observation and responses to cross-sectional survey measures (spot-check observation, selfreported hand washing and a hand washing demonstration) and discusses the suitability of indicators. Focus group discussions with fieldworkers were also conducted. The results of this study indicate that hand washing behaviours were over-reported compared with structured observation findings. This implies that current estimates of hand washing from large scale surveys, for example, Demographic and Health Surveys (DHS) are also likely to be overestimates. In about 1000 households, approximately 1% or less of female caregivers were observed to wash their hands with soap or ash before preparing food, before eating, and 3% before feeding a child. Hand washing with soap was higher for defecation related events with approximately 29% of female caregivers using soap two thirds or more of the time after cleaning a child’s anus/disposing of a child’s stools and 38% used soap two-thirds or more of the time after defecation. Soap was observed at the hand washing location in about 50% of the households but actual practice was much lower. Reported knowledge was high; approximately 90% identified the important times for hand washing as being before eating and after defecation and approximately 50% identified before preparing food and after cleaning/changing a baby. The measurement of hand washing is complex and there has been limited research into the validity of different measurement methods. This research used an epidemiological style approach using the concepts of screening/diagnostic testing and calculation of kappa statistics to assess validity. In conclusion, this research demonstrates that self report hand washing measures are subject to over reporting. Structured observation provides useful information on directly observed hand washing behaviours and the frequency of behaviours. Spot check methods of soap and hand washing locations also provide more optimistic data than observations and can be used as an alternative to structured observation. In addition, the use of questions on the 24 hour recall of soap and other self report questions on knowledge and the availability of spare soap demonstrate potential for use as potential indicators as an alternative to structured observation. Further validation of measurement methods is required in different country settings.
Supervisor: Falkingham, Jane Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: HN Social history and conditions. Social problems. Social reform ; HA Statistics ; RJ101 Child Health. Child health services