Improving handwashing promotion in humanitarian crises

Principal Investigator: Sian White (LSHTM)


Collaborators: Jean Lapegue (ACF), Melinda Foran (CAWST), Val Curtis and Karl Blanchet (LSHTM)


In stable settings, handwashing with soap is known to be one of the most cost-effective public health interventions, reducing diarrhoeal disease up to 48% and contributing to the reduction of undernutrition. When a humanitarian crisis occurs, whether it be a disease outbreak, a natural disaster or a protracted conflict, the social and physical environments of the affected population are disrupted. These disruptions result in behavioural shifts, including to behaviours of public health significance, such as handwashing with soap. There is a dearth of literature on hygiene behaviour and its determinants in emergencies. This is a significant issue for crisis-affected populations whose disease risk increases in the wake of an emergency. It is also an issue for emergency responders. While this evidence remains lacking it will impede the development of effective hygiene programs. The proposed research will map the determinants of hygiene behaviour and understand the constraints of hygiene programming within these crises settings. It will involve a multi-stage literature review, a policy analysis and a multi-country qualitative case study, with the aim of drawing recommendations for practitioners.


The objectives of this research will be:

  • To develop a deep understanding of the determinants of hand hygiene in emergency settings so as to contribute to the development of rapid and effective behaviour change intervention tools


The field work for this research will take place in Kurdistan, Iraq and the Kivus, and the Democratic Republic of Congo (DRC). In Kurdistan, we will assess the determinants of behaviour among Internally Displaced Persons (IDPs) living in and outside camps during a protracted conflict. DRC is regularly affected by cholera outbreaks and will act as a case study of how people behave in a disease outbreak. We will assess the determinants of behaviour before and during a cholera outbreak.


This research brings together the expertise of Action Contre la Faim (ACF), the London School of Hygiene and Tropical Medicine (LSHTM) and the Centre for Affordable Water and Sanitation Technology (CAWST). The study is funded by the US Office of Foreign Disaster Assistance (OFDA).