Baseline Data to Guide Handwashing Intervention in Peru

A new technical paper from the World-Bank administered Water and Sanitation Program (WSP) found that only half of care-givers in 3,526 households in rural Peru report washing hands with soap at times of fecal contact, and that 10 percent of children under five presented diarrhea symptoms in the previous 48 hours – although on average 55 percent of caregivers did not seek medical advice.  An average of 20 percent of households surveyed had no sanitation facilities of any type.

WSP is testing approaches to learn what works to create and sustain handwashing with soap behavior change. To establish the causal effect of project interventions on specific health and welfare measures, the project is conducting an impact evaluation (IE) using a randomized-controlled experimental design. The study, Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Peru by Sebastian Galiani and Alexandra Orsola-Vidal,includes pre-intervention (baseline), concurrent (longitudinal), and post-intervention (endline) surveys administered by WSP-contracted firms in each project country (Peru, Senegal, Tanzania, and Vietnam).

“The Water, Sanitation, and Hygiene sector is one where data is certainly lacking,” said Bertha Briceno, senior impact evaluation specialist for the project.  ”This study offers new, relevant data that will help us determine the health impacts of these hygiene interventions and shed some light on the role of behavior change.”

Data for the baseline survey was collected on a range of indicators, including household characteristics, education, income, water sources, sanitation, handwashing facilities and behavior, child environment, handwashing determinants, relationship between family and school, prevalence of diarrhea and other diseases, and child development. The baseline survey methodology included structured observations of handwashing behaviors of caregivers; community and household questionnaires; and collection of water microbiology (hand rinses) and child fecal samples.

The baseline survey and other IE studies will provide a better understanding of at-scale hygiene interventions and generate robust evidence on a cross-country basis, increasing knowledge on how the effects of an intervention can vary according to each country’s programmatic and geographic contexts.

In Peru, the Global Scaling Up Handwashing Project has been implemented in 788 randomly selected districts in a total of 104 provinces. The overall project objective is to improve the health of rural populations at risk of diarrhea and acute lower respiratory infectionthrough a strategic communications campaign aimed at stimulating and sustaining handwashing behavior change in women (ages 14–49) and children (ages 5–12).

For more information about Global Scaling Up Handwashing and related publications, visit www.wsp.org/scalinguphandwashing or contact Eduardo Perez, wsp@worldbank.org.

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Eduardo Perez
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