Handwashing with soap
Factsheet
October 2010

The simple action of handwashing with soap is an integral part of the Australian aid, Water And Sanitation Hygiene (WASH), program helping to achieve the Millennium Development Goals (MDGs).  
The challenge is to make handwashing with soap an automatic behaviour performed in homes, schools and communities worldwide. In developing countries this is literally a life and death issue.
Handwashing facts
>	Handwashing at critical times including before eating or preparing food and after using the toilet can reduce diarrhoea rates by almost 40 per cent.
>	Handwashing with soap can reduce the incidence of acute respiratory infections by around 23 per cent.
>	Pneumonia (a lower respiratory infection) is the number one cause of mortality among children under five years old, taking the lives of an estimated 1.8 million children per year.
>	A study has assessed the effect of hand washing promotion with soap on the incidence of pneumonia and found that children younger than five years in households that received plain soap and hand washing promotion had a 50 per cent lower incidence of pneumonia than those households that did not have soap.
>	Handwashing can be a critical measure in controlling pandemic outbreaks of respiratory infections. Several studies carried out during the 2006 outbreak of severe acute respiratory syndrome (SARS) suggest that washing hands more than 10 times a day can cut the spread of the respiratory virus by 55 per cent.
>	Handwashing with soap has been cited as one of the most cost-effective interventions to prevent diarrhoeal related deaths and disease.
>	A review of several studies shows that handwashing in institutions such as primary schools and day care centres reduce the incidence of diarrhoea by an average of 30 per cent.
>	Rates of handwashing around the world are low. Observed rates of handwashing with soap at critical moments, that is, before handling food and after using the toilet, range from zero per cent to 34 per cent.
>	A recent study shows that handwashing with soap by birth attendants and mothers significantly increased newborn survival rates by up to 44 per cent.
>	The lack of soap is not a significant barrier to handwashing with the vast majority of even poor households having soap. Soap was present in 95 per cent of households in Uganda, 97 per cent of households in Kenya and 100 per cent of households in Peru.
>	Water alone is not enough and soap is rarely used for handwashing. Laundry, bathing and washing dishes are seen as the priorities for soap use.
>	New studies suggest that handwashing promotion in schools can play a role in reducing absenteeism among primary school children. In China, for example, promotion and distribution of soap in primary schools resulted in 54 per cent fewer days of absence among students compared to schools without such an intervention.
Sources
Hugh Waddington, Birte Snilstveit, Howard White, and Lorna Fewtrell, ‘Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries’, cited in International initiative for Impact Evaluation, Synthetic Review 001, 3IE, 2009.
Jeroen Ensink (Quality Assurance Val Curtis), WELL Factsheet on handwashing with soap, http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/Handwashing.htm
UNICEF, State of the World’s Children 2008, http://www.unicef.org/sowc08/ 
Tom Jefferson, Chris Del Mar, Liz Dooley, Eliana Ferroni, Lubna A Al-Ansary, Ghada A Bawazeer, Mieke L van Driel, Ruth Foxlee, Alessandro Rivetti, Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review, BMJ 2009;339:b3675, doi: 10.1136/bmj.b3675 (published 22 September 2009).
Cairncross, S, Valdmanis, V, ‘Water supply, sanitation and hygiene promotion’, chapter 41 in Disease Control Priorities in Developing Countries, Jameson et al (eds), second edition, World Bank, Washington DC, 2006, www.dcp2.org/pubs/dcp 
Cochrane, Ejemot, RI, Ehiri, JE, Meremikwu, MM, Critchley, JA, ‘Hand washing for preventing diarrhoea’, Cochrane Database of Systematic Reviews, Issue 1. Art. No. CD004265, DOI: 10.1002/14651858.CD004265.pub2, 2008.
Scott, B, Curtis, V & Rabie, T, Protecting children from diarrhoea and acute respiratory infections: the role of handwashing promotion in water and sanitation programmes, WHO Regional Health Forum, 7, 42–47, 2003.
Victor Rhee, Luke C Mullany, Subarna K Khatry, Joanne Katz, Steven C LeClerq, Gary L Darmstadt, James M Tielsch, ‘Maternal and Birth Attendant: Hand Washing and Neonatal Mortality in Southern Nepal’, Archives of Pediatrics & Adolescent Medicine, 162(7):603-608, 2008.
Valerie A Curtis , Lisa O Danquah & Robert V Aunger, Planned, motivated and habitual hygiene behaviour: an eleven country review, Health Educ. Res. 24: 655-673, 2009.
Global Handwashing Day Planners Guide, Second Edition, http://www.globalhandwashingday.org/Global_Handwashing_Day_2nd_Edition.pdf, pg. 41.
Bowen, et al, A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools, American Journal of Tropical Medicine and Hygiene, 76(6), 2007, pp. 1166–1173.