Hand washing with soap is the first line of defence against Novel Coronavirus and COVID-19 disease. Yet many of us do not always wash our hands when we have to, nor are we always able to do so. What makes this seemingly simple act so hard to practice?
Hand washing comprises cleaning hands with water and soap at times when bacteria and viruses are mostly likely to enter the body – before cooking, eating and feeding children; after defecating, cleaning a child’s bottom, disposing a child’s stool; and after any other contaminating task.
Hand washing at these critical times is a highly cost-effective public health intervention, reducing diarrhoea diseases by 47% and respiratory infections by 23%.
In India, people may be aware of hand washing, yet the actual practice of hand washing with soap at important times is abysmally low. The National Family Health Survey 4 (2015-16) found that 96.3% of rural households had a place to wash hands. However, only 49.4% of these spaces had soap and water, 19.4% had only water, and 11.5% had neither. Another study in rural India found high rates of hand washing after defecation (99.3%) and before eating (91.9%), but lower rates at other times related to childcare activities, particularly when feeding infants and young children (26.3%), and disposing of child faeces (16.7%). Soap was the preferred cleansing agent for activities that involved contact with faecal matter (e.g., toilet use), but was less used for activities that did not involve such contact. These findings highlight two important implications for COVID_19 prevention:
First, the materials required for hand washing, namely water and soap, are not always available, and second, awareness of hand washing with soap is higher for after toilet use (visible contamination), but not for other times.
With the potential progression of the Novel Coronavirus pandemic into rural India and low-income urban communities, we must emphasise hand washing with soap at all critical times and stress that everyone cleans their hands (children, adolescents, adults). We must break down why hand washing with soap is so effective against this disease – soap dissolves the fat layer in the virus, inactivating it. Access to water needs urgent attention. Many households in rural areas and slum communities have limited water, making hand washing difficult. Water use is rationed among competing demands, with hygiene practices afforded a lower priority.
With the advent of summer months, water scarcity will be acute in many parts of India, further challenging the practice of this disease preventing behaviour.
Emerging issues have to be tackled urgently and sensitively. Community and public toilets have common toilets and hand washing stations, used by hundreds. A significant number of rural and slum residents draw water from common water points (hand pumps and taps), posing yet another risk for contamination and transmission. Discrimination and exclusion come to the forefront with migrant workers and families heading back to their rural homes, and traditionally marginalised groups continuing to be denied access to urgently needed resources, including water.
At this time, we need to facilitate the first line of defence of hand washing for rural and low-income urban communities, migrants, and marginalised households. Awareness messages on hand washing must reach everyone - urban and rural populations, men and women, children, literate and illiterate groups, those with and without access to resources. Messages must be clear, in comprehensible audio and visual formats, and through channels that can be easily disseminated to and accessible by all.
As we currently respond on a war footing, we must simultaneously start thinking about planning for the next phase when the “curve flattens''. Hand Washing needs to be a habit, and to this end, rural and urban communities must have access to sufficient water. Solutions to collect and store water for hygiene purposes (e.g., rain water harvesting) can be explored, instituted, and strengthened, with a focus on water stressed communities.
Government public health and nutrition programs can be expanded to incorporate hygiene behaviours in general and hand washing in particular as key health promotion and disease prevention measures.
The POSHAN Abhiyan, for instance, can promote hand washing among pregnant and lactating mothers, adolescent girls, and children attending anganwadis. ASHAs, anganwadi workers, teachers, can disseminate hygiene messages in communities through household visits, during health events, and in schools. The Swachh Bharat Mission, in its second phase, can further promote hand washing under ODF sustainability.
Hand washing should not be propelled to the forefront as an urgent disease prevention measure during crises. Hand washing with soap should be a deeply inculcated habit supported by sufficient water and sanitation resources. Let us use this crisis to help our communities be better prepared in times of need and normalcy.
(Arundati Muralidharan is Manager-Policy, (WASH in Health & Nutrition, WASH in Schools) at WaterAid India)
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