With the onset of the coronavirus disease 2019 (COVID-19) pandemic, much effort has gone into propagating the importance of hand and face hygiene, to prevent the spread of this viral illness by respiratory droplets and surfaces (or ‘fomites’) contaminated by such droplets. India was no exception, with a massive public health campaign directed at educating the general public on these transmission prevention measures.
A new preprint published on the medRxiv* server explores the results of such campaigns on handwashing practices in rural Odisha, India.
The study involved 131 participants. Surveys were carried out through phone calls, involving the 73 heads of households, 37 caregivers of young children below the age of 5, and 21 members of the Village Water and Sanitation Committee (VWSC) in two rural districts of Odisha, namely, Ganjam and Ganapati. The study covered 43 villages in the region.
The interviews were during the lockdown period between May and July 2020. At this period, thousands of migrant workers returned home from other states, with a resulting surge in COVID-19 cases. In fact, Ganjam became a focus of the disease in Odisha.
The villages surveyed were part of a water, sanitation, and hygiene (WASH) infrastructure building program called MANTRA (Movement and Action Network for Transformation in Rural Areas), carried out by the non-governmental organization Gram Vikas. This included building a bathing space with a latrine in all households and a piped water system to each household with a community.
More frequent and thorough handwashing
The pandemic-related health education led to improved and more frequent handwashing in this region, as reported by 86% of participants.
Not only did people wash their hands more often, they did it more thoroughly after seeing audiovisual demonstrations of the proper way to wash their hands. They also reported an increased tendency to use soap to wash their hands.
This change persisted even months into the pandemic, indicating the formation of a new cultural habit. Interestingly, mothers and other caregivers indicated they trained their children to wash their hands properly and often, as well. Moreover, handwashing became a default practice after a trip away from home, indicating a new and important habit was being formed.
This could lead to a huge and beneficial change in the extent of spread of various respiratory and feco-oral pathogens such as typhoid, influenza, cholera and diphtheria. Earlier studies have reported the occurrence of this phenomenon in Mexico, following the earlier H1N1 pandemic of influenza.
Similar results have been reported both in other parts of India, and in Kenya and Ethiopia, against the background of the ongoing pandemic.
The cost of soap and the difficulties faced in finding enough water were two obstacles to building this habit, as mentioned by 8% and 6% of respondents, respectively. It is noteworthy that relative to a similar study in Uganda, among slum residents and students, only a small minority of participants in rural Odisha reported lack of soap and other hand sanitizers, or the lack of running water, as a barrier to handwashing, compared to 60% and 34%, respectively, in Uganda.
As with any desired behavioral change, a physical environment that facilitates and promotes such changes is highly desirable. “These findings illustrate how the provision of soap and reliable water supply are needed to enable individuals to practice the promoted preventative measure of handwashing.”
The information about handwashing was primarily obtained from television news, community-level government workers, social media, and the internet, in any combination.
This was accompanied by improvements in water supply to villages. Most households had a piped water connection, but the supply was intermittent, though predictable. As a result, most continued to store water for their needs over the next 24 hours.
About half the VWSC members said the water supply had changed following COVID-19. The changes included water treatment, water tank cleaning, an increase in the hours of water supply or sometimes a decrease. However, 84% reported that they had adequate water.
This indicates that further steps should be taken to ensure that water is treated at the point of use to make sure drinking water is potable, especially in villages where chlorination is inadequate.
Many participants reported that village water tanks were cleaned or chlorination carried out by local government workers. Most respondents indicated increased treatment of household water, and better household cleaning practices. This may reflect a voluntary initiative to prevent the spread of COVID-19 resulting from the emphasis on cleanliness. Whether or not they break the COVID-19 chain of transmission, they will definitely reduce the caseload of diarrheal disease in this area.
Household toilets continued to be used as usual, since the study was carried out in a village with high latrine coverage and use. There was no change in the way child defecation was carried out despite the onset of the pandemic.
What are the implications?
The WASH program invested heavily in improving village-level infrastructure, including village-level piped water supply and household latrine construction. This is likely to have helped to comply with COVID-19 preventive measures, since the availability of water and sanitation facilities at home allowed householders to stay home and wash their hands often
These findings may help to expand compliance to public health recommendations to prevent COVID-19, as well as preparing for future pandemics. It is important to know that the villages studied came under the MANTRA program, which introduced piped water connections and built household latrines for all houses in the area. This high level of WASH compliance may not be true of other areas where water supply is inadequate or unpredictable, and where sanitary facilities are lacking.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.