Facilitating hand hygiene in displacement camps during the COVID-19 pandemic: a qualitative assessment of a novel handwashing stand and hygiene promotion package

Sian White; Anika Jain; Abie Bangura; Michelle Farrington; Melaku Mekonen; Bang Chuol Nhial; Enamul Hoque; Md Moniruzzaman; Pascaline Namegabe; John Walassa; Fiona Majorin

doi:10.1186/s13031-022-00492-8

Facilitating hand hygiene in displacement camps during the COVID-19 pandemic: a qualitative assessment of a novel handwashing stand and hygiene promotion package

Confl Health. 2022 Dec 16;16(1):65. doi: 10.1186/s13031-022-00492-8.

Authors

Affiliations

¹ Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. Sian.white@lshtm.ac.uk.
² Independent Consultant, New York, USA.
³ Oxfam, John Smith Drive, Oxford, UK.
⁴ Oxfam in Ethiopia, Bole Sub-city, Addis Ababa, Ethiopia.
⁵ Department of Public Health, Gambella University, Gambella Town, Gambella, Ethiopia.
⁶ Oxfam in Bangladesh, RAOWA Complex, VIP Road, Dhaka, 1206, Bangladesh.
⁷ Oxfam in DRC, Goma, Democratic Republic of Congo.
⁸ Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.

Abstract

Background: Handwashing with soap is critical for the prevention of diarrhoeal diseases and outbreak related diseases, including interrupting the transmission of COVID-19. People living in large displacement settings are particularly vulnerable to such outbreaks, however, practicing handwashing is typically challenging in these contexts.

Methods: We conducted a qualitative assessment of the implementation of a combined intervention to facilitate handwashing behaviour in displacement camps and in surrounding communities in Bangladesh, Ethiopia and the Democratic Republic of Congo during the COVID-19 pandemic. The intervention comprised a 'hardware' infrastructural component (provision of the Oxfam Handwashing Station) and a 'software' hygiene promotion package (Mum's Magic Hands). We used programmatic logbooks, interviews with implementation staff and focus group discussions with crisis-affected populations to assess the use, feasibility and acceptability of the intervention.

Results: Both components of the intervention were viewed as novel and appealing by implementing staff and crisis-affected populations across the study sites. The acceptability of the handwashing station could be improved by redesigning the tap and legs, exploring local supply chain options, and by providing a greater number of facilities. The implementation of the hygiene promotion package varied substantially by country making it challenging to evaluate and compare. A greater focus on community engagement could address misconceptions, barriers related to the intuitiveness of the handwashing station design, and willingness to participate in the hygiene promotion component.

Conclusions: The combination of a 'hardware' and 'software' intervention in these settings appeared to facilitate both access and use of handwashing facilities. The acceptability of the combined intervention was partially because a great deal of effort had been put into their design. However, even when delivering well-designed interventions, there are many contextual aspects that need to be considered, as well as unintended consequences which can affect the acceptability of an intervention.

Keywords: COVID-19; Displacement camps; Handwashing; Hygiene promotion; Refugees.