Conflict and Health
Volume 9, Issue 1, 2015

Soap is not enough: Handwashing practices and knowledge in refugee camps, Maban County, South Sudan (Article) (Open Access)

Phillips R.M.* , Vujcic J. , Boscoe A. , Handzel T. , Aninyasi M. , Cookson S.T. , Blanton C. , Blum L.S. , Ram P.K.
  • a Centers for Disease Control and Prevention, Atlanta, GA, United States
  • b University of Buffalo, Buffalo, NY, United States
  • c Oxfam International, Juba, Sudan
  • d Centers for Disease Control and Prevention, Atlanta, GA, United States
  • e Oxfam International, Juba, Sudan
  • f Centers for Disease Control and Prevention, Atlanta, GA, United States
  • g Centers for Disease Control and Prevention, Atlanta, GA, United States
  • h Dakar, Senegal
  • i University of Buffalo, Buffalo, NY, United States

Abstract

Background: Refugees are at high risk for communicable diseases due to overcrowding and poor water, sanitation, and hygiene conditions. Handwashing with soap removes pathogens from hands and reduces disease risk. A hepatitis E outbreak in the refugee camps of Maban County, South Sudan in 2012 prompted increased hygiene promotion and improved provision of soap, handwashing stations, and latrines. We conducted a study 1 year after the outbreak to assess the knowledge, attitudes, and practices of the refugees in Maban County. Methods: We conducted a cross sectional survey of female heads of households in three refugee camps in Maban County. We performed structured observations on a subset of households to directly observe their handwashing practices at times of possible pathogen transmission. Results: Of the 600 households interviewed, nearly all had soap available and 91 % reported water was available "always" or "sometimes". Exposure to handwashing promotion was reported by 85 % of the respondents. Rinsing hands with water alone was more commonly observed than handwashing with soap at critical handwashing times including "before eating" (80 % rinsing vs. 7 % washing with soap) and "before preparing/cooking food" (72.3 % vs 23 %). After toilet use, 46 % were observed to wash hands with soap and an additional 38 % rinsed with water alone. Conclusions: Despite intensive messaging regarding handwashing with soap and access to soap and water, rinsing hands with water alone rather than washing hands with soap remains more common among the refugees in Maban County. This practice puts them at continued risk for communicable disease transmission. Qualitative research into local beliefs and more effective messaging may help future programs tailor handwashing interventions. © 2015 Phillips et al.

Author Keywords

Emergencies South Sudan Handwashing Sanitation Refugees Hygiene Structured observation Soap

Index Keywords

[No Keywords available]
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84951862764&doi=10.1186%2fs13031-015-0065-2&partnerID=40&md5=8d3f62f9fc7138c16f9651be534ae777
DOI: 10.1186/s13031-015-0065-2
ISSN: 17521505
Cited by: 9
Original Language: English