doi:10.4269/ajtmh.14-0378 Copyright © 2015 by The American Society of Tropical Medicine and Hygiene Observed Practices and Perceived Advantages of Different Hand Cleansing Agents

Abstract. Bangladeshi communities have historically used ash and soil as handwashing agents. A structured obser-vation study and qualitative interviews on the use of ash/soil and soap as handwashing agents were conducted in rural Bangladesh to help develop a handwashing promotion intervention. The observations were conducted among 1,000 randomly selected households from 36 districts. Fieldworkers observed people using ash/soil to wash their hand(s) on 13 % of occasions after defecation and on 10 % after cleaning a child’s anus. This compares with 19% of people who used soap after defecation and 27 % after cleaning a child who defecated. Using ash/soil or soap was rarely (< 1%) observed at other times recommended for handwashing. The qualitative study enrolled 24 house-holds from three observation villages, where high usage of ash/soil for handwashing was detected. Most informants reported that ash/soil was used only for handwashing after fecal contact, and that ash/soil could clean hands as effectively as soap