Am. J. Trop. Med. Hyg., 81(1), July 2009, pp. 140-145

Difficulties in Maintaining Improved Handwashing Behavior, Karachi, Pakistan

Stephen P. Luby*, Mubina Agboatwalla, Anna Bowen, Eben Kenah, Yushuf Sharker, AND Robert M. Hoekstra

Centers for Disease Control and Prevention, Atlanta, Georgia; Health Oriented Preventive Education, Karachi, Pakistan; International Centre for Diarrhoeal Disease, Bangladesh, Dhaka, Bangladesh; University of Washington University School of Public Health and Community Medicine, Seattle, Washington

In an earlier study in Karachi, Pakistan, households that received free soap and handwashing promotion for 9 months reported 53% less diarrhea than controls. Eighteen months after the intervention ended, these households were enrolled in a follow-up study to assess sustainability of handwashing behavior.

Upon re-enrollment, mothers in households originally assigned to the intervention were 1.5 times more likely to have a place with soap and water to wash hands (79% versus 53%, P = 0.001) and when asked to wash hands were 2.2 times more likely to rub their hands together at least three times (50% versus 23%, P = 0.002) compared with controls. In the ensuing 14 months, former intervention households reported a similar proportion of person-days with diarrhea (1.59% versus 1.88%, P = 0.66) as controls.

Although intervention households showed better handwashing technique after 2 years without intervention, their soap purchases and diarrhea experience was not significantly different from controls.

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