By Diana Pinto
Picture a typical handwashing scene at a day care center in a developing country. A class of roughly 15 children lines up to use the sink; however, water only flows from the tap some of the time or the sink doesn’t work at all, so water must be fetched in containers from a faraway tank.
Proper hand hygiene is key for the prevention of acute diarrhea and respiratory infections, which are the leading causes of mortality and morbidity in children under 5. Handwashing with soap and water has proven to be the most cost-effective intervention for the prevention of these illnesses. Promoting hand and face washing practices in different communities in the region, particularly among children, is an important component of IDB projects throughout Latin America and the Caribbean, but what to do when water is not available?
The fact is that a large proportion of the population burdened by these diseases lives in places where water is either a scarce natural resource or in limited supply due to infrastructure deficiencies. However, while handwashing in and of itself is simple and the rationale behind it appears readily understood by people, encouraging behavioral changes to ensure its adoption and compliance can be quite difficult. The practicality of handwashing with soap in high-demand situations such as health care settings and schools is questionable and can certainly become a barrier to compliance. In the scene depicted above, if the kids strictly followed recommended handwashing instructions, it would take the entire class a half hour to wash its hands, at the expense of learning or play activities. Thus, it’s a priority to identify hand hygiene alternatives for scenarios where water constraints or behavioral barriers are likely to be an issue.
I recent conducted a study with a group of Colombian researchers and found a lower incidence of acute diarrhea and respiratory infections in children ages 1 to 5 attending child care centers where alcohol-based hand rubs (hand sanitizers) were made available. In their study “A cluster-randomized controlled trial of handrubs for prevention of infectious diseases among children in Colombia,” they randomly assigned 42 childcare centers with sporadic and limited tap water availability to use alcohol-based hand rubs as a complement to handwashing with soap and water or to continue regular handwashing practices.
The results of this study support considering alcohol-based hand rubs as an option for national public health policies. For one, they’re cheap—the use of alcohol-based hand rubs during a 210-day school year would cost just US$2.50 per child. What’s more, the perceived convenience and satisfaction with the product reported by the teachers in the study gave the hand rubs an advantage over handwashing with soap and water. Furthermore, their use could provide a temporary solution in settings with scarce water resources and inadequate sanitary facilities and supplies.
Although promising, the potential role of alcohol-based hand rubs as a public health tool may be further determined by studies on their cost-effectiveness as compared with other hand hygiene options, factors influencing the adoption of procedures in different settings, and effective ways to facilitate long-term behavior change and technology adoption in diverse cultural contexts.
Diana Pinto is a Health Lead Specialist in the IDB’s office in Washington DC.