Could the Supertowel be used as an alternative hand cleaning product for emergencies? An acceptability and feasibility study in a refugee camp in Ethiopia

Sian White, Jessica F Petz, Kifle Desta, Torben Holm Larsen, Sian White, Jessica F Petz, Kifle Desta, Torben Holm Larsen

Abstract

Background: Diarrhoeal diseases are a major contributor to morbidity and mortality in humanitarian crises. Handwashing with soap may reduce diarrhoea by up to 47%, however, the circumstances associated with displacement make it challenging for crisis-affected populations to be able to wash their hands with soap. The Supertowel is an alternative hand-cleaning product, proven to be as efficacious as handwashing with soap. The Supertowel is a micro-fibre towel with an anti-microbial treatment. When dipped in water it is capable of removing and killing pathogens from hands. This study aims to assess whether the Supertowel could be an acceptable and feasible product for crisis-affected populations.

Methods: The study took place in an Eritrean refugee camp located in Tigray state in Ethiopia. We used a mix of qualitative methods to understand use and acceptability, including baseline observations (n = 13), behaviour trials involving interviews at three time points (n = 19) and focus group discussions (n = 3). We thematically analysed data from interviews and discussions.

Results: Participants indicated that the Supertowel was convenient, easy to use and saved them water and money. All households participating in the behaviour trials had at least one Supertowel in use at the end of the trials (follow-up visit two). In discussions participants reported that the Supertowel was more desirable than comparable hand cleaning products. In interviews, trial participants explained that the product enabled them to clean their hands at times when they might not normally bother. The research also identified some issues with the smell of the Supertowel and its intuitive use.

Conclusions: The Supertowel was found to be an acceptable and useful hand-cleaning product that could complement soap use in crisis contexts. This pilot study also identified areas of future research including the need to compare different distribution models for the Supertowel (distribution in hygiene kits compared to distribution with an accompanying communication package) and to evaluate its use at scale over a longer time period.

Conflict of interest statement

We have read the journal's policy and the authors of this manuscript have the following competing interests: Sian White, Jessica F Petz and Kifle Desta declare no conflicts of interest. Torben Holm Larsen has a patent pending for the SuperTowel. He is also a full time employee of Real Relief, the private company which developed the SuperTowel and which holds the IPR of the product. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Initial image used in the…
Fig 1. Initial image used in the focus group discussion.
Fig 2. Second set of images used…
Fig 2. Second set of images used in the focus group discussion.

References

    1. Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. The Lancet. 2004;364(9449):1974–83. 10.1016/S0140-6736(04)17481-3.
    1. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet Infectious Diseases. 2003;3(5):275–81. 10.1016/S1473-3099(03)00606-6.
    1. Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JPT, Wolf J, et al. Systematic review: Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Tropical Medicine & International Health. 2014;19(8):906–16. 10.1111/tmi.12339
    1. Peterson EA, Roberts L, Toole MJ, Peterson DE. The effect of soap distribution on diarrhoea: Nyamithuthu Refugee Camp. International journal of epidemiology. 1998;27(3):520–4. Epub 1998/08/11. .
    1. Phillips RM, Vujcic J, Boscoe A, Handzel T, Aninyasi M, Cookson ST, et al. Soap is not enough: handwashing practices and knowledge in refugee camps, Maban County, South Sudan. Conflict and Health. 2015;9:39 10.1186/s13031-015-0065-2 PMC4689052.
    1. Watson J, Dreibelbis R, Aunger R, Deola C, King K, Long S, et al. Child's play: Harnessing play and curiosity motives to improve child handwashing in a humanitarian setting. Int J Hyg Environ Health. 2018. Epub 2018/09/17. 10.1016/j.ijheh.2018.09.002 .
    1. Biran A, Schmidt WP, Zeleke L, Emukule H, Khay H, J P, et al. Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya. Trop Med Int Hlth. 2012;17(9):1133–41.
    1. Ramesh A, Blanchet K, Ensink JHJ, Roberts B. Evidence on the Effectiveness of Water, Sanitation, and Hygiene (WASH) Interventions on Health Outcomes in Humanitarian Crises: A Systematic Review. PloS one. 2015;10(9):e0124688–e. 10.1371/journal.pone.0124688 .
    1. Vujcic J, Ram PK, Blum LS. Handwashing promotion in humanitarian emergencies: strategies and challenges according to experts. Journal of Water, Sanitation and Hygiene for Development. 2015;5(4):574–85. 10.2166/washdev.2015.009
    1. Gibson KE, Crandall PG, Ricke SC. Removal and transfer of viruses on food contact surfaces by cleaning cloths. Applied and environmental microbiology. 2012;78(9):3037–44. 10.1128/AEM.00027-12 .
    1. Rheinland TuV. Bioefficacy Test Results 2016.
    1. Labs ITL. Safepad wash test and antimicrobial efficacy. RealRelief Website: RealRelief, 2016.
    1. Labs ITL. MRSA kill over time. RealRelief Website: RealRelief, 2014.
    1. Labs ITL. Bacterial Kill Rate. REalRelief Website: RealRelief, 2016.
    1. Labs ITL. Kill rate over time—hospital cloth. RealRelief website: RealRelief, 2016.
    1. Torondel B. Efficacy of the Supertowel: An alternative handwashing product for humanitarian emergencies. in press.
    1. UNHCR. Camp Profile: Hitsats Refugee Camp 2018.
    1. Etikan I, Musa SA, Alkassim RS. Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics. 2016;5(1–4). 10.11648/j.ajtas.20160501.11
    1. Biran A, Tabyshalieva A, Salmorbekova Z. Formative research for hygiene promotion in Kyrgyzstan. Health Policy and Planning. 2005;20(4):213–21. 10.1093/heapol/czi024
    1. Hulland KR, Leontsini E, Dreibelbis R, Unicomb L, Afroz A, Dutta NC, et al. Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health. 2013;13(1):877 10.1186/1471-2458-13-877
    1. World Health Organisation. Hand Hygiene: Why, How & When? Geneva: 2009.
    1. Hirai M, Graham JP, Mattson KD, Kelsey A, Mukherji S, Cronin AA. Exploring Determinants of Handwashing with Soap in Indonesia: A Quantitative Analysis. International journal of environmental research and public health. 2016;13(9):868 10.3390/ijerph13090868 .
    1. Tong A, Craig J, Sainsbury P. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6):349–57. 10.1093/intqhc/mzm042
    1. Ashraf S, Nizame FA, Islam M, Dutta NC, Yeasmin D, Akhter S, et al. Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh. American Journal of Tropical Medicine & Hygiene. 2017;96(2):421–9. 10.4269/ajtmh.16-0304 .
    1. Clayton DA, Griffith CJ, Price P. Consumers’ attitudes, knowledge, self-reported and actual hand washing behaviour: a challenge for designers of intervention materials. International Journal of Consumer Studies. 2003;27(3):223–4. 10.1046/j.1470-6431.2003.00308_22.x
    1. Dobe M, Mandal RN, Jha A. Social determinants of good hand-washing practice (GHP) among adolescents in a rural Indian community. Family & Community Health. 2013;36(2):172–7. 10.1097/FCH.0b013e318282ac42 .
    1. Contzen N, De Pasquale S, Mosler H-J. Over-Reporting in Handwashing Self-Reports: Potential Explanatory Factors and Alternative Measurements. PloS one. 2015;10(8):e0136445–e. 10.1371/journal.pone.0136445 .
    1. Oliveira ea. Monitoring hand hygiene: direct observation versus self-report rates Enfemeria Global. 2017;48.
    1. Ram PK, Luby SP, Halder AK, Islam MS, Granger S. Improving measures of handwashing behavior Bangladesh 2007. Report on preliminary findings2009.
    1. Cairncross S, Cuff JL. Water use and health in Mueda, Mozambique. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1987;81(1):51–4. 10.1016/0035-9203(87)90280-X
    1. Stelmach RD, Clasen T. Household water quantity and health: A systematic review. International journal of environmental research and public health. 2015;12(6):5954–74. 10.3390/ijerph120605954 .
    1. Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. Geneva: 2018.
    1. OXFAM. Field testing new handwashing kit prototype in Tanzania 2018.
    1. Save the Children. User centred engagement for child-friendly sanitation design in rapid-onset emergencies 2018.
    1. Watson J, Dreibelbis R, Aunger R, Deola C, King K, Long S, et al. Child's play: Harnessing play and curiosity motives to improve child handwashing in a humanitarian setting. International Journal of Hygiene and Environmental Health. 2018. 10.1016/j.ijheh.2018.09.002.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj