Handwashing practices and challenges in Bangladesh.

Handwashing is universally promoted in health interventions. Studies in Bangladesh and elsewhere have shown a 14 - 40% reduction of diarrhoeal diseases with handwashing. The perceptions and methods related to washing of hands vary widely in Bangladesh. Socio-economic factors are also associated with methods practised. In general, the effectiveness of handwashing practices is poor. Faecal coliform bacteriological counts were reported to be high for both left and right hands. About 85% of women studied who lived in slums and 41% of rural women washed their hands using only water. However, most women rubbed their hands on the ground, or used soil, and rinsed them with water during post-defecation handwashing. Most women claimed that they could not afford to buy soap. Experimental trials showed that use of soap, ash or soil gave similar results when women washed their hands under the same conditions. The washing of both hands, rubbing of hands, and the amount and quality of rinsing water used were found to be important determinants in the reduction of bacterial counts on hands. Although handwashing messages have been revised by most of the main programmes after these studies, there is scope for further improvement, as well as evaluation of their impact.