A 2009 study performed by Practical Action Nepal Office with its partners in the surrounding urban areas of Gulariya municipality in Midwestern Nepal revealed that most people there wash their hands before eating food and after going to toilet. The survey performed in six poor communities with more than 5,000 people showed that 99 and 93 percent people wash their hand before eating food and after going to toilet, respectively. It shows that there are still some people who do not wash hands at critical times.
Another data is even scarier: only 12 percent people wash their hands with soap water before eating food; mostly (85 percent) wash hands just with water. More than 50 percent people do not wash hands with soap water after going to toilet. It is also interesting to know that there is a misconception that excreta of breast-fed children is not harmful; thus people do not wash their hand after touching it. More than 40 percent people admitted to not washing their hand after anal cleansing of their children.
Each year 1.5 million people, mostly children under five, die of diarrhea globally. Proper hand washing with soap is the most effective intervention to reduce such cruel losses. It is even more important in Nepal as most people use hands for anal cleansing as well as eating food, creating high risks of fecal oral transmission. Looking at the importance of hand washing, Global Handwashing Day has been celebrated every October 15 since 2008. This year more than 100 countries celebrated the day, with the theme of “Help More Children Reach Their Fifth Birthday”.
Similar to other developing countries, water-related diseases are amongst the top killers in Nepal. Around 14,700 people are dying each year because of unsafe water, lack of sanitation and unhygienic behaviors; around 12,700 children under five die because of acute respiratory infection (ARI) and diarrheal disease annually due to poor hygiene and sanitation. The Nepali state loses around Rs 10 billion each year in health expenses, loss of productivity and negative effect in tourism because of poor hygiene and environmental sanitation.
To overcome this situation, raising awareness on washing hands with soap water at critical times is very important. Capacity building of local change agents like female community health volunteers (FCHVs), school teachers and students and their effective mobilization in awareness campaigns can accelerate better health outcomes. On the other hand, there are other people who know about the importance of hand washing but do not practice it. There is a proverb that it is very difficult to wake a person pretending to be asleep. It is because the behavior change is complex.
People normally do not easily accept new habits although they might be beneficial. One of the effective ways is to train people on good habits from their childhood. Home and school can be a good platform to learn healthy habits. Generally, hand washing facilities like wash basin and soap case are so high up that children find it difficult to reach them. Thus, there is also a need to consider child-friendly facilities in schools where children spend a significant portion of their time. Children can be effective change agents. There are several examples of children changing the habit of adults.
There is no doubt that proper hand washing with soap-water saves life. Washing hands with water alone is far less effective than washing with soap, irrespective of its kind. Maintaining good personal hygiene along with provisions of safe drinking water and better sanitation further reduce environmental health risks. Prevention is always better than cure; thus let us join hands to creating healthy homes through healthy habits and leave behind unhygienic behaviors.
The author is project manager, Urban Water Sanitation and Waste, Practical Action Nepal