Africa Water, Sanitation & Hygiene November 2018 Vol.13 No.5 | Page 27

Hygiene
Innovative ‘Surprise Soap’ gets children washing hands in emergencies, with
lifesaving implications
Children
who had fled
their homes
because of
conflict were
four times
more likely
to wash their
hands with
soap if it was made in a fun and innovative way, according
to research published in International Journal of Hygiene
and Environmental Health.
The study, led by the London School of Hygiene &
Tropical Medicine (LSHTM), Save the Children and
Field Ready looked to find a way to increase rates of
handwashing in emergency settings.
Researchers gave families in a displaced persons camp in
Iraq a soap with a visible toy embedded in the centre. The
more children used the soap, the quicker they reached the
toy. Children in the camp were involved in choosing the
toys that were used, before they were manufactured locally
using 3D printers.
The findings show that play may be the key to increasing
handwashing and saving lives in emergencies. It is the
first time a motive-based handwashing approach has been
tested with children in an emergency.
Handwashing is one of the most cost-effective ways of
saving lives worldwide. It can reduce rates of pneumonia –
the disease that kills more children than any other – by up
to 21% and rates of diarrhoeal diseases like cholera by up
to 23%. Pneumonia killed almost 900,000 children under
the age of five in 2016 and diarrhoea caused the deaths of
480,000.
Children caught up in emergencies are especially
vulnerable to death and illness caused by poor hygiene, as
they are forced to flee or shelter in dirty conditions.
The team conducted the research as humanitarian aid
providers have long found that providing soap along
with health and hygiene information has a limited impact
on increasing handwashing, and so new approaches are
needed.
In the study children in forty households in the camp
were given the ‘Surprise Soap’ delivered along with short,
fun and interactive household sessions that didn’t involve
talking about health. Alongside this a control group of
children in forty households in the same camp were given
normal soap and sessions explaining the health benefits of
handwashing and good hygiene - mirroring the approach
often taken in emergencies around the world.
Four weeks later, researchers found that children who
received the ‘Surprise Soap’ intervention were four times
more likely to wash their hands with soap at crucial
moments, such as before eating or after using the toilet,
than if they had not received the intervention, based on a
comparison to the control group.
Julie Watson, who led the pilot programme at LSHTM,
said: “We saw straight away that the children were excited
about the toy soaps. The results were very promising and
show the value of using innovative design as a tool for
behaviour change.
“If we can successfully scale up this intervention it has the
potential to have a huge health impact in emergencies –
and ultimately to save lives.”
The project was underpinned by the ‘Evo-Eco’ theory,
developed by LSHTM experts, which suggests that all
human behaviour is driven by fifteen innate motives,
including ‘hunger’ and ‘disgust’ – as well as ‘play’ and
‘curiosity’ – those tested in the study. These motives
have developed because they help people achieve goals
important to evolution, such as finding food.
Claudio Deola, Senior Humanitarian Water, Sanitation
and Hygiene Advisor at Save the Children, said: “We have
known for a long time that in the midst of the conflict
and displacement the simple act of handwashing saves
lives. But in the chaotic aftermath of fighting or a natural
disaster, we see time and again that providing soap and
information is only part of the picture. We needed to think
creatively.
“Not only were children more likely to wash their hands,
but the pilot achieved this without the need for labour-
intensive hygiene-promotion. This is so important when
you need to be quick and are short of resources in the
critical first phase of an emergency response.”
The researchers say that their study provides evidence that
this rapidly deployable intervention may have the potential
to be rolled out as standard in emergencies worldwide.
The team are now looking to further test the ‘Surprise
Soaps’ intervention in different, more challenging
humanitarian contexts and to assess the long term
behavioural and health impacts.
The authors acknowledge the limitations of their
study including a differential drop-out rate in both the
intervention and control groups, which may reflect some
underlying difference between the two groups that could
bias results. In addition, the risk of the ‘Hawthorne
Effect’, which suggests individuals may modify their
behaviour in response to their awareness of being
observed.
The study was funded by the Humanitarian Innovation
Fund.
Africa Water, Sanitation & Hygiene • November 2018
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