Validity of rapid measures of hand washing behavior : an analysis of data from multiple impact evaluations in the global scaling up hand washing project

There is increasing interest in improving hand washing in low- and middle-income countries. The validity of rapid hand washing measures was evaluated by comparing them to hand washing behavior measured during five-hour structured observations. Hand washing was measured in the impact evaluation of the global scaling up hand washing project, carried out by the water and sanitation program (WSP) in Peru, Senegal, and Vietnam. Global scaling up hand washing tested the effects of at-scale implementation of hand washing promotion on various outcomes, including behavior and health, in four countries, Peru, Senegal, Tanzania, and Vietnam using cluster-randomized controlled trial designs. Structured observations were carried out among a subset of households participating in end line surveys in each country. Regression was used to model the relationship between the rapid hand washing measure and the probability that hands were washed during the observed event, accounting for the repeated nature of structured observation data. This multi-country analysis of the validity of rapid hand washing measures confirms the utility of observing hand washing materials at the places where people wash hands, at the times most necessary for washing them (after fecal contact and before food preparation). The findings described reinforce the global imperative of improving hand washing behavior for prevention of the leading causes of death in young children.