Abstract
Abstract
Background: Hand washing with soap is crucial for infection transmission prevention. However, despite its effectiveness in reducing infections, globally the proportion of individuals who comply is low at only 19%, varying between developed (48-72%) and developing countries (5-25%). In Africa, basic hand washing facility coverage is at 15%, and in Kenya, the same is estimated at 18%. During the COVID-19 pandemic, awareness and hand washing practices increased globally including Kenya. However, hand-washing adoption often declines soon after crises/pandemics. Informal settlements, such as Viwandani, are harder hit by handwashing challenges because of limitations in access to water and handwashing facilities. Moreover, these communities are more vulnerable to other non-hygiene-related infectious diseases. Data on hand washing practices is sparse more so among populations living in informal settlements. Also, there is need to identify interventions for sustained hand washing with soap in these communities.
Objectives: To explore handwashing practice among the slum population, in a post-pandemic era. Specifically, the study 1) assessed adherence to and techniques of handwashing used in main hand washing hotspots in slum residents of Viwandani, Nairobi, 2) assessed perceptions, facilitators, and barriers to sustaining adherence to hand washing with soap after COVID-19 by slum residents in Viwandani, Nairobi, 3) explored the motivation and mechanism through which hand washing with soap can be sustained among some slum residents in Viwandani, Nairobi and 4) assessed availability and readiness of handwashing facilities at identified hand washing hotspots in Viwandani, Nairobi.
Methods: The study used direct observation, key informant interviews (KIIs), focus group discussions (FGDs), and in-depth interviews (IDIs) to collect information on adherence to and techniques of handwashing, perceptions, facilitators, and barriers to sustaining handwashing with soap, as well as the motivations and mechanisms through which handwashing with soap can be sustained including availability and readiness of handwashing facilities. The work concluded with a consultative workshop to propose a pilot concept for sustained hand washing with soap in Viwandani.
First, the research team, with the assistance of the community advisory committee (CAC) members, familiar with the local set up identified hot spots for handwashing. The CAC is a dedicated group that helps identify local health needs and develops ways to address those needs using community approach. The CAC is composed of members elected by respective constituent groups that they represent. The members represent government, local leaders/village leaders, the youth, women, older persons, school administrators, healthcare providers, faith-based organizations/community-based organizations/local non-governmental organizations, community health volunteers, media/education and entertainment organizations, religious groups and people living with disabilities.
Then, we conducted covert observations at the identified hotspots across Viwandani, focusing on both handwashing facilities and their users. Each hotspot had two observation sessions in which several individuals were observed, one session in the morning (9:00 AM to 1:00 PM) and another in the afternoon (1:00 PM to 5:00 PM). From each observation session, we purposively selected one individual for IDI, meaning that we conducted two (2) in-depth interviews from each observation site. In addition, we engaged CAC members in FGDs to further explore the community motivation and the mechanisms for sustained hand washing with soap. We also gathered additional insights from KIIs drawn from individuals representing facilities in the hotspot list. These were institutional leaders or owners of these hotspots or focal persons who are well informed about hand washing with soap. Lastly, we convened a consultative workshop bringing together representatives from the County health officials, local administration,interview participants, CAC, and representatives of the facilities within the hotspots to collaboratively propose a pilot concept for sustained hand washing with soap in Viwandani. We conducted thematic analysis of the data.
Significance: In resource-constrained slum environments, where costly interventions like sanitation upgrades may not be feasible and the risk for transmission of infectious diseases is high, it is crucial to understand how existing resources are utilized for handwashing with soap. This project generated insights into current practices, identified factors that influence the use of available resources,and explored motivation mechanisms and assess availability and readiness of facilities for hand washing with soap in Viwandani. The findings inform the design or improvement of sustainable handwashing interventions, contributing to more effective disease prevention strategies.
Duration: 12 months (March 2024 to February 2025)
Budget: USD 10,000
Lay summary
Washing hands with soap is important for preventing the spread of pathogens. But not many people around the world do it regularly - only about 19%. This varies depending on where you live, with richer countries having higher rates (around 48-72%) and poorer countries having lower rates (about 5-25%). During the COVID-19 pandemic, governments including Kenyan, ran campaigns to get people to wash their hands more, and they set up lots of handwashing stations. More people started washing their hands because they feared getting sick. As a result, besides prevention of COVID-19 transmission, additional benefits were realized including reduction of diarrheal and other respiratory infections. But in the past, when there have been outbreaks of diseases, people start washing their hands more, but then they stop again soon after. A survey in Nairobi found that after six months, most of the handwashing stations were still working, and lots of people were using them properly. But a year later, fewer people were using them, and some of the stations were abandoned.
Through this study, we sought to understand how people in the slums of Viwandani in Nairobi were washing their hands after the COVID-19 pandemic. We worked with the community to come up with ways to encourage people to keep washing their hands regularly. Specifically, we engaged CAC members to identify hotspots for handwashing with soap in their community, then observed people in the identified hotspots to see how they washed their hands in places where they were supposed to. Out of those that we observed, we picked out some and talked to them to find out what they thought about washing their hands with soap and what made it hard for them to keep doing it, as well as what motivated some people to keep washing their hands and how we could help others do the same. Additionally, we held discussions with the CAC team that did the hotspot mapping to gather more information on the community perspective of hand washing with soap. We also talked to key informants to gather further insights. Finally, we held a workshop to bring together representatives from the County health officials, local administration, interview participants, the CAC, and representatives from the facilities in the hotspot list. They collaboratively proposed a pilot concept for Viwandani community that could encourage regular hand washing with soap. We analyzed the data to find common themes and insights.
This study appreciates that in poor areas like slums, it is not easy to do big things like upgrade sanitation systems. So, it is important to focus on simple things like washing hands with soap, which could help stop diseases from spreading. But even though washing hands is cheap and effective, not many people keep doing it regularly. This study helped us understand why and proposed ways to fix it, as suggested by the community itself.
The study lasted for 12 months, from March 2024 to March 2025.
The budget for the study is $10,000.
