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J Public Health (Oxf). 2019 Nov 18. pii: fdz130. doi: 10.1093/pubmed/fdz130. [Epub ahead of print]

Hand washing behavior change effect of community-based hygiene and sanitation intervention in low resource setting.

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Prime Institute of Public Health, Riphah International University, Islamabad 46000, Pakistan.



Lack of hygiene and sanitation causes significant disease, disability and death. Majority of diarrheal diseases are related to hygiene and drinking water. Hand washing with soap after toilet use and before eating reduces these risks significantly.


This report is based on a behavior change project in the rural community setting (union council Nahqi), Peshawar, Pakistan aimed to improve hygiene- and sanitation-related behavior. A pre-intervention survey was conducted at household level (n = 958), followed by a structured behavior change communication program with motivational and educational material and key health messages for three months. Lastly, an end-line survey was conducted measuring change in practice domains.


All the domains of hygiene and sanitation showed statistically significant improvement (11-59% P < 0.001), including handwashing before meals (28.2%), before cooking (54.1%), before child feeding (21.2%), after defecation (30.6%); tooth brushing twice daily (7.3%); nail clipping at least weekly (16.3%); bathing daily (11.3%); change of clothing twice weekly (24.7%); covering the water containers (59.3%) and house orderliness (30.6%).


The findings conclude that a behavior change communication program that is in accord with community needs, level of their understanding, beliefs and sociocultural norms is well received for positive behavior change.


handwashing; health behavior; health promotion; hygiene


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