POST-DEFECATION HANDWASHING IN BANGLADESH - PRACTICE AND EFFICIENCY PERSPECTIVES

Inadequate handwashing after defecation and anal cleaning practices in the Indian subcontinent is an important source of faeco-oral transmis sion of enteric diseases. To better understand the process as traditio nally practised, 90 women in semi-rural Bangladesh were observed washi ng hands after defecation. Several components of handwashing practices were identified: the cleaning agent, using left or both hands; freque ncy of rubbing hands, type and amount of water used to wash, and the d rying of hands on the wearer's clothes. A subsequent experiment was co nducted to assess the effect of currently practised handwashing and dr ying according to standardised procedure on faecal coliform count of h ands. As a rubbing agent, soil was commonly used (40%); soap was used by 19% and was reported unafforable by about 81% of the non-users. Goo d handwashing behaviour was positively associated with better social a nd economic indicators including education of the women observed. Both hands were unacceptably contaminated after traditional handwashing (t he geometric mean count of left was 1,995 and right hand was 1,318 fae cal coliform units/hand). After standardising the observed components of handwashing procedures the use of any rubbing agent, i.e. soil, ash or soap, produced similar acceptable cleaning. Use of a rubbing agent (e.g, soil, ash or soap), more rubbing (i.e. six times), rinsing with safer water (e.g. 2 litres of tubewell water) and drying with a clean cloth or in the air produced acceptable bacteriological results. Comp onents of traditional handwashing practices were defined through caref ul observation, and experiments on handwashing with standardised compo nents showed that efficient and affordable options for handwashing can be developed; this knowledge should be helpful in disease control pro grammes.