While I was driving on one of the streets of Accra recently, a colleague drew my attention to a man who was busily washing his hands in water that had collected on the shoulders of the road as a result of a downpour the previous night.
Naturally we were all intrigued by the sight we beheld and starred earnestly to see what right-thinking person would be doing an act we viewed as very strange.
Imagine our relief when we found out a short while later that it was after all, a mentally challenged person. It was not strange to us anymore, which confirmed to us that no sane person would perform such act without thinking of the repercussions.
My colleague then commented that whereas the man we saw might not suffer later from that act of washing his hands with dirty and contaminated water, any other healthy person might be plagued with some diseases later. That is however debatable because when germs enter the blood stream, the result is an illness, whether immediately or later.
Washing of hands
But while no one may want to wash his or her hands with dirty or contaminated water like the mentally ill man, worldwide, people rinse their hands with water, in the common belief that rinsing with water alone results in clean hands because it removes visible dirt.
Nonetheless, many studies have found that rinsing one’s hands with water alone is significantly less effective in removing germs than washing them with soap. Washing the hands with soap, however, is seldom practised.
Research reveals that the observed rates of handwashing with soap at critical times (after using the toilet or cleaning a child’s bottom and before handling food) around the world, in industrialised and developing nations, ranges from zero to 34 per cent.
Low rates of handwashing are rarely caused by a lack of soap. Soap is present in the vast majority of households worldwide, but it is commonly used for bathing and laundry, not for handwashing.
Lack of water is usually not a problem either, as the hands can be effectively washed with little or recycled water. In studies around the world, one major reason for a small number of people washing their hands with soap is that this is simply not a habit.
Global Handwashing Day
It is in view of these, that Global Handwashing Day (GHD) has been instituted and is held annually on October 15. It is a worldwide celebration of handwashing with soap that aims to foster and support a global and local culture of handwashing with soap; shine a spotlight on the state of handwashing in each country and raise awareness about the benefits of handwashing with soap.
Global Handwashing Day, originally created for children and schools, is endorsed by a wide array of governments, international institutions, civil society organisations, NGOs, private companies, and individuals.
Over one billion people in over 100 countries around the world including Ghana are estimated to have marked the day this year, which has as its theme: “The power is in your hands.”
In Ghana, this year’s national commemoration was held at the Jumapo Methodist Park near Koforidua, Eastern Region with the theme: “Saving Lives Through Handwashing: The Power is in your Hands”
Handwashing behaviour in Ghana is an issue
According to Mrs Theodora Adomako – Adjei, Extension Services Coordinator, Community Water and Sanitation Agency (CWSA), although Ghanaians generally allege that they wash their hands with soap after using the toilet or cleaning up a child who has defecated and before handling food, eating or feeding a young child, the observed rates of people washing their hands with soap are very low.
According to the Extension Services Coordinator, that is not one of the cherished hygienic practices in Ghana, because it is common to find people using their hands unhygienically and going ahead to use the same contaminated hands to eat and serve others with food.
She maintains that “In Ghana the foods we like most include: Kenkey, Banku, Fufu, Tuo- Zafi and Ampesi and that while “the preparation processes of these foods involve vigorous use of the hands, most Ghanaians also enjoy eating these foods with their hands.”
“It is amazing what Ghanaians use their hands for, apart from using them to cook and eat. Some of the uses of hands are: cleaning of the bottom after using the toilet, picking of the nose, cleaning the ears, scratching itchy parts of the body, rubbing eyes, cleaning mucus from the nose, coughing and sneezing into the hands, scratching the hair, handling money and touching contaminated surfaces, among others,” Mrs Theodora Adomako–Adjei said.
She indicated that it is common to find food vendors using their bare hands to dish out food, adding “some people buy boiled eggs and ask vendors to remove the shells; roasted groundnut sellers remove husks from the groundnut with their hands and after that blow the husks away - A sure and easy way of contamination through droplets from the mouth.”
Mrs Theodora Adomako-Adjei expressed worry that after using the hands to do the things aforementioned, most people do not wash the hands before handling food and caterers may not wash their hands before, during and after cooking.
Why it isn’t enough to rinse the hands with water alone
It has been found that the more common practice of rinsing the hands with water alone is significantly less effective than washing the hands with soap.
This is because fecal germs lodge in the natural oils of hands, and water alone will not dislodge them. Using soap, therefore, adds to the time spent washing, removes the oils carrying most germs, and leaves hands smelling pleasant.
Washing the hands with water alone means the germs or pathogens are still present and would be ingested with the food eaten.
The “critical moments” when hands should be washed with soap
Hands should be washed with soap after using the toilet or cleaning a child’s bottom and before handling food – e.g., before cooking, eating and feeding a child.
The “correct” way to wash hands
Experts say proper handwashing requires soap and only a small amount of water. Running water from a tap is not necessary; a small basin of water or “Tippy Tap” - cans or plastic bottles that release just enough for a clean hand wash each time they are tipped - is sufficient.
They say a person should cover wet hands with soap; scrub all surfaces, including palms, back, between the fingers, and especially under fingernails for about 20 seconds; rinse well with running water rather than still water, and dry on a clean cloth or by waving in the air.
The World Health Organisation (WHO) estimates that diarrhoeal infections claim the lives of 1.87 million children under five each year, making diarrhoea the second most-common cause of death among children under five.
Diarrhoeal diseases are often described as water-related, but more accurately, they are excreta-related since the germs come from faecal matter. These germs make people ill when they enter the mouth through hands that have been in contact with faeces.
According to the WHO, washing the hands with soap breaks the disease cycle. In 2005, Fewtrell et al. 2005 (a hygiene research), compared the effectiveness of washing the hand with soap to reduce diarrhoea-related illness to other interventions.
Acute respiratory infections
Acute respiratory infections such as pneumonia are another primary cause of child deaths, which handwashing reduces by removing respiratory pathogens (germs) found on hands and surfaces, and by removing other pathogens found to cause diarrhoea and respiratory symptoms. Evidence suggests that better hygiene practices – washing hands with soap after defecation and before eating – could cut the infection rate by about 25 per cent.
A study in Pakistan found that washing the hands with soap reduced the number of pneumonia-related infections in children under five by more than 50 per cent, as well as skin infection – impetigo – by 34 per cent.
Intestinal worm infections
Research further shows that washing the hands with soap reduces incidents of infections like intestinal worms, especially ascariasis and trichuriasis.
Benefits Beyond Health - The cost-effectiveness of handwashing
Handwashing with soap is the single most cost-effective intervention and it reduces disability-adjusted life years (DALYs) related to diarrhoeal diseases by a significant margin. Research shows that every $3.35 invested in handwashing programmes prevents one disability-adjusted life year (DALYs).
In comparison, gaining that same year by promoting latrines would cost $11, and promoting household water connection would cost more than $200. Failing to invest in handwashing promotion, therefore, means missing very inexpensive life-saving opportunities.
Each year, diarrhoeal diseases and pneumonia together kill two million under-five aged children in developing countries.
Children from 20 per cent of the poorest households are more than 10 times as likely to die as children from 20 percent of the richest households.
The hands are the principal carriers of disease-causing germs.
It is estimated that washing the s with soap could avert one million of those deaths.
Washing the hands with soap after using the toilet or cleaning a child and before handling food can reduce diarrhoeal disease cases by nearly one-half and those of respiratory infections by about one-quarter.
This feature was first published in the Daily Graphic on October 21, 2013