Education in Crisis and Conflict
Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries
A mixed-method systematic review
This report summarises a systematic review by De Buck and colleagues that examines which promotional approaches are effective in changing handwashing and sanitation behaviour and which implementation factors affect the success or failure of such interventions. The authors find that promotional approaches can be effective in terms of handwashing with soap, latrine use, safe faeces disposal and open defecation. No one specific approach is most effective.Sanitation and hygiene messaging was described in 15 effectiveness studies and 5 implementation studies:
- Fourteen studies across South Asia (Bangladesh, India and Pakistan), South East Asia (Thailand), East Asia (China), Latin America (Peru) and Sub-Saharan Africa (Uganda) evaluated the effects of sanitation and hygiene messaging; and
- Of these, four studies described school-based interventions in Sub-Saharan Africa (Nigeria, Kenya and Tanzania)
- Five studies reported on enablers of, and barriers to, sanitation and hygiene messaging: three at the school level in rural Kenya, Tanzania and Viet Nam.
The effectiveness evidence for sanitation and hygiene messaging on handwashing and sanitation behaviour (Figure 7) can be summarised:
- Sanitation and hygiene messaging may improve handwashing with soap during programme implementation. Studies could not find post-implementation or longer term effects;
- Sanitation and hygiene messaging may make little or no difference on sanitation outcomes. Studies found no effects on latrine use and open defecation. In the one study examining the effect on safe faeces disposal (the Growth and Development Programme in urban communities in Peru), results were inconsistent;
- Sanitation and hygiene messaging did not consistently improve knowledge of health, personal hygiene and the causes of diarrhoea;
- No consistent effect on skills and attitude was shown;