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Photo: Hands under a water pump

Children wash their hands at a pump on the first Global Handwashing Day in the Kibera slum of Nairobi, Kenya on October 15, 2008.  Public health organizations are enlisting the help of corporations to find novel ways to promote hand washing, which could help save millions of children from sickness or death.

Photograph by Tony Karuma, AFP/Getty Images

by Eliza Barclay

for National Geographic News

Published June 30, 2010

This story is part of a special series that explores the global water crisis. For more, visit National Geographic's Freshwater website.

Wash your hands—it's the advice of parents, doctors, and many advertisements, especially during cold and flu season.

That's because the simple act of scrubbing your hands with soap is a cheap and quick way to prevent some diseases.

In the developing world, hand washing is even more critical. An estimated 2.2 million children under the age of five die from diarrheal diseases each year, spread in part by dirty hands—both their own and their caregivers’, according to the World Health Organization (WHO). Hand washing with soap—along with household water treatment and sanitation—can reduce rates of diarrheal diseases by 44 percent, according to WHO.

But public health experts have to spend millions of dollars a year persuading people to wash their hands. And even then, some people don't have the luxury of piped water, or have only one bar of soap that's used for laundry.

(See freshwater pictures in National Geographic magazine.)

That's why some experts are drawing on the experience of consumer marketers to encourage hand washing even in places where water and soap are scarce.

(See: "Sexy Marketing Aims to Boost Toilet Use.")

Agencies such as the humanitarian group UNICEF, which targets children and mothers, are partnering with private companies such as Procter & Gamble to push hand washing as a positive behavior, instead of just a public health message.

"We know now even when people know what's good for them, they don't do it," said Ann Thomas, a sanitation and hygiene specialist at UNICEF in New York. "So now we have to look at motivators for behavior change that we know work."

Hand-Washing Strategies: Glitter and Good Mothers

For instance, visualization is one way to get people's attention, Thomas said. She and her colleagues in the field have found that glitter turns out to be an effective tool in schools in the United States and increasingly in the developing world for demonstrating how easily germs move from one person to others. When one child receives a sprinkling of glitter, soon all the other children have the sparkly stuff on their hands. Chalk can do the trick, she said, as can dirt.

Thomas is also targeting mothers who strive to prove their worth to their peers. In Ghana, for example, UNICEF has developed advertisements promoting hand washing as the act of a good mother.

(Related: "Hand Washing Wipes Away Regrets?")

This strategy was largely pulled from the experience of corporate partners: Companies like Procter & Gamble and Unilever, which sell soap products and are part of the Global Public-Private Partnership for Handwashing with Soap, have decades of experience encouraging consumers to try new things.

Hand Washing Catches On

Another way to increase hand washing, Thomas said, is to bring water closer to children who don't have it at school.

In rural areas in many parts of Africa, Asia, and Latin America, schoolchildren are forced to walk long distances for water, which means it's less likely that they'll wash their hands after using the latrine.

So instead of waiting for governments to install large-scale water projects, experts have been trying a number of new, simpler tactics to encourage hand washing. (Learn about our hidden water uses.)

For instance, the U.S. Centers for Disease Control and Prevention (CDC) and its partners installed water stations, provided disinfectant for water, and trained teachers and students about hygiene in 17 rural schools in western Kenya.

A peer-reviewed research study on the project—funded by Procter & Gamble, a major producer of soap products—revealed some promising results, researchers say. Proper hand-washing techniques increased 240 percent among students and 164 percent among their adult caregivers after the intervention.

"One thing is very clear: If you teach pupils, they will learn it," said study co-author Rob Quick, a CDC medical epidemiologist. "When the knowledge of pupils goes up, the knowledge of their parents go up, and the practices in school change and parents' behavior changes."

Hand-washing programs in schools are also helping to reduce absenteeism, because children are missing fewer days due to illness.

But Cliff Ochieng, a coordinator with the Safe Water and AIDS Project in Kenya, said it can be challenging to maintain the hand-washing stations. Ochieng organizes similar hygiene projects in local schools.

"Should the systems wear out or get broken down one way or the other," he said, "the [hand-washing trend] is . . . disrupted."

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