Understanding the gap between knowledge and practice of handwashing in rural India: evidence from a cross-sectional study.

Limited studies in India had captured the gap in knowledge and practice of handwashing in the community. This study assesses the gap in knowledge and practice of handwashing in rural India. The study was conducted across 10 districts in five states of India - Andhra Pradesh, Assam, Maharashtra, Odisha and West Bengal from December 2021 to January 2022 by the SIGMA Foundation, Kolkata in collaboration with UNICEF India. Descriptive statistics, bivariate analysis, creation of indices and multinomial logistic regression were employed. Findings demonstrated that both knowledge of different aspects of hand hygiene and practice of handwashing with soap and water (HWWS) at critical times varied by socio-economic groups and also across the districts/states. Half of the respondents used only water to wash their hands after taking meals, before serving food, whenever their hands seemed dirty and before eating or cooking. Overall, the 'HWWS knowledge index' was 0.46, whereas the 'HWWS practice index' was 0.36. The correlation coefficient between the two was 0.36. The HWWS practice index was lower than the HWWS knowledge index for 50% of the sampled households. Both HWWS knowledge and practice indices were higher among females, higher educated and younger population. The gap between handwashing practice and knowledge was also higher among females and higher educated.

Bridging the rural–urban divide in sanitation with a cluster-based approach to faecal sludge management: a case study from Dhenkanal district in Odisha, India

Despite the importance of safe sanitation and hygiene for sustainable development and public health, approximately half of India's rural population lacks access to safely managed sanitation. Policies prioritizing improved sanitation access have accelerated coverage, yet barriers to universal access and use remain. In this paper, we investigate how personal experience with a public health shock impacts recall of public health messages and households' sanitation and hygiene practices. Using a panel survey conducted before and after the first wave of the COVID-19 pandemic, and the resulting lockdown, in Bihar, India, we compare public health messaging recall and hygiene and sanitation behaviors among households that experienced severe economic disruptions due to the COVID-19 lockdown and those that did not. We find that households that experienced economic disruptions had a higher recall of public health messaging around safe sanitation and hygiene. In addition, households that experienced these disruptions reported more social distancing, increased handwashing behavior, and reduced open defecation. A major public health shock, the COVID-19 pandemic, increased messaging around the importance of safe hygiene and sanitation for public health in India. We find that personal experience increased the salience of public health messaging, with positive returns to sanitation and hygiene practices.