2011年-世界发展银行全球_Scaling_Up_Handwashing_Behavior___Findings_from_the_Impact_Evaluation_Baseline_Survey_in_Senegal_76页_3mb

Global Scaling Up Handwashing Project: Summary of Baseline Survey in Senegal

Core Content

The Global Scaling Up Handwashing Project, initiated by the Water and Sanitation Program (WSP) in December 2006, aims to improve health and welfare outcomes for millions of poor people by promoting handwashing with soap at critical times. The project focuses on four countries: Peru, Senegal, Tanzania, and Vietnam, and involves a randomized-controlled impact evaluation (IE) to measure the effectiveness of the interventions.

In Senegal, the initiative began in 2003 with the creation of the Public-Private Partnership for Handwashing with Soap (PPPHW), supported by WSP. The goal is to stimulate and sustain handwashing behavior among mothers and caregivers aged 14–49 and children up to 13 years old, with a particular emphasis on reducing the risk of diarrhea and improving child health and development.

The project employs a multi-channel promotional strategy, drawing from commercial and social marketing, to influence handwashing behavior. These channels include:

• Mass media campaigns (national and local levels)
• Direct consumer contact (DCC) events
• Interpersonal communication at the household level

Main Objectives

The primary objectives of the project are:

• To reduce the incidence of diarrhea and improve health outcomes through sustained handwashing behavior
• To increase household productivity by promoting better hygiene practices
• To scale up successful handwashing interventions globally
• To develop and disseminate evidence-based knowledge products and advocate for handwashing as a public health priority

Key Findings from the Baseline Survey

Household Demographics

• Average household size: 12.2 members
• Average number of children under five: 2.7
• Average household head age: 50.5 years
• Secondary education attainment: 27%
• Average monthly per capita income: 10,778 CFA (≈ $23 USD)
• Majority of households (83%) are employed

Access to Water and Sanitation

• 70% of households have access to improved water sources
• Access decreases with poverty, reaching 37% in poorer households
• 70% of households have access to improved sanitation
• 20% practice open defecation
• Fatick has the lowest access to both improved water and sanitation

Handwashing Behavior

• 97.4% of caregivers self-report handwashing with soap in the past 24 hours
• Only 37% report handwashing at critical times (e.g., after using the toilet, before feeding a child)
• True handwashing behavior observed is three times lower than self-reported rates
• Poorer households are half as likely to report handwashing at critical times compared to wealthier ones

Access to Handwashing Facilities

• Only 1/3 of households have a designated handwashing place with soap and water
• 12% of poorer households have such facilities

Child Health and Development

Diarrhea Prevalence

• 1 in 11 children under five had diarrhea symptoms in the two weeks before the survey
• 1 in 10 had symptoms in the previous week
• 1 in 7 had symptoms in the previous 48 hours
• Lower prevalence is observed in households with handwashing stations
• Diarrhea incidence is higher in Kaolack compared to Fatick

Acute Lower Respiratory Infection (ALRI)

• 2.7% of children under five had ALRI symptoms in the previous 14 days
• ALRI prevalence is higher in households with handwashing stations
• Wealthier quintiles also report higher ALRI symptoms, though not statistically significant
• St Louis has the highest ALRI prevalence, while Fatick has the lowest

Anemia

• 90.7% of children in the sample had anemia
• Anemia is lower in households with handwashing stations (87.7%) compared to those without (92.4%)
• Lower rates are also observed in children with access to improved water and sanitation
• Anemia rates are lowest in the 3rd and 5th wealth quintiles

Parasite Prevalence

• Giardia and Cryptosporidium are the most common parasites
• Cryptosporidium prevalence is lower in households with handwashing stations (11.1% vs. 19.7%)
• Giardia prevalence is higher in households with improved water and sanitation
• Small sample size limits the statistical weight of these correlations

Child Nutrition and Development

• Underweight: 10.2%
• Stunting: 12.7%
• Wasting: 8.9%
• Stunting is significantly lower in households with handwashing stations (8.9% vs. 14.5%)
• Child development scores are higher in households with handwashing facilities
• Fatick outperforms St Louis in child development across all indicators

Methodology

• The baseline survey was conducted between June and August 2009 in four regions of Senegal
• 1,600 households and 110 clusters were surveyed across 88 communes
• Data was collected on demographics, health, sanitation, and handwashing behavior
• Structured observations and community questionnaires were also used
• Randomized-controlled trial (RCT) design was used to assess the impact of the intervention

Conclusion

The baseline survey provides a comprehensive understanding of the current state of handwashing behavior, access to water and sanitation, and child health outcomes in Senegal. It highlights the low rates of handwashing with soap at critical times, despite the general handwashing frequency, and underscores the importance of designated handwashing stations in improving health outcomes. The project's impact evaluation aims to measure the long-term effects of the intervention and inform future scaling efforts.

The findings suggest that handwashing behavior is closely linked to socioeconomic status, with wealthier households more likely to engage in critical handwashing practices. However, child health outcomes such as anemia and stunting show positive correlations with access to handwashing facilities, indicating the potential health benefits of the project. The IE will help to validate these findings and guide the implementation of future handwashing programs.