Most prior handwashing studies have been carried out in South Asia.This report examines the unmet need to estimate handwashing behavior using practical measures that yield valid indicators of handwashing behavior across cultural and geographic contexts.
- Observation of handwashing materials at the places where people wash hands, at the times most necessary for washing, is a valid measure of handwashing with soap in multiple cultural and geographic contexts.
- Only one third of fecal contact events in Peru and one quarter in both Senegal and Vietnam were followed by handwashing with soap. Soap use was substantially lower at other critical times.
- Having soap at the place to wash hands after toileting, and having water at that place, were independently associated with observed handwashing with soap after fecal contact.
- There is a lack of an association between proximity of the handwashing location and observed handwashing behavior.
- Self-reported measures not consistently associated with observed handwashing.