Global Handwashing Day: Five Diseases India Can Stamp Out By Focusing On Handwashing

New Delhi: “Wash your hands.” These are perhaps the three most important words the world has heard since the COVID-19 breakout – the worst pandemic to hit the world in 100 years. Even in the pre-COVID times, handwashing was considered as a cost-effective public health intervention for reducing disease burden, but its importance and practice always remained a challenge, especially in India. The National Family Health Survey 4 (2015-16) highlighted the grim situation of handwashing in the country. According to the survey, while almost all households in India (as high as 97 per cent have washbasins), only richer and more educated households in urban areas use soap to wash hands. The survey also pointed out that only 2 out of 10 poor households use soap compared to 9 out of 10 rich households.

Also Read: #SwasthBharat: What Are The Different Types Of Germs And Ways To Guard Against Them In Everyday Life

World Health Organization (WHO) states that hands are the main pathways of germ transmission and thus hand hygiene is the single most important measure to avoid the spread of infections and keep people healthy. It further adds that staggeringly, if world leaders don’t continue to invest in handwashing, we will continue to see more than a million children under five years old dying unnecessarily every single year around the world. It adds, thoroughly cleaning hands with soap or an alcohol-based hand rub helps prevent a range of diseases, including the biggest killers of under-fives globally: pneumonia and diarrhoea.

WHO says that in 2019 an estimated 5.2 million children under 5 years died mostly from preventable and treatable causes. Children aged 1 to 11 months accounted for 1.5 million of these deaths while children aged 1 to 4 years accounted for 1.3 million deaths. Newborns (under 28 days) accounted for the remaining 2.4 million deaths. And an additional 500,000 older children (5 to 9 years) died in 2019. WHO also said that half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo and Ethiopia. Nigeria and India alone accounted for almost a third of all deaths. The leading causes of death in children under-5 years are preterm birth complications, pneumonia, congenital anomalies, diarrhoea and malaria, all of which can be prevented or treated with access to simple, affordable interventions including hygiene, adequate nutrition, safe water and food.

Also Read: #SwasthBharat: Hand Hygiene – Why, How & When. A Quick Guide

On Global Handwashing Day 2021, we take a look at how focussing on hand hygiene can stamp out few diseases from India, which take lives of many in the country:

Diarrhoea: According to WHO, Diarrhoea is a gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms. The infection is spread through contaminated food or drinking-water, or from person to person as a result of poor hygiene. It can pass on to infants if they are not exclusively breastfed in the first 6 months of their life.

WHO also states that earlier severe dehydration and fluid loss were the main causes of diarrhoea deaths but now other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhoea-associated deaths.

As per the National Health Mission data, around one lakh children die due to diarrhoea in India, ever year. Centers for Disease Control and Prevention states that teaching people about handwashing helps them and their communities stay healthy. It further states that handwashing can:

a. Reduce the number of people who get sick with diarrhoea by 23-40% in the world
b. Reduce diarrhoeal illness in people around the world with weakened immune systems by 58%

Explaining the importance of hand hygiene, Arundati Muralidharan, Policy Manager from WaterAid India said,

So you have toilets that you’re using to relieve yourself but then you are not washing your hands, so the faecal matter is in your hands. You need to wash your hands with soap and water and that is something we need to look into – how to promote hygiene. I think hygiene is the biggest missing piece of the puzzle in our country. Even for mothers, when you’re feeding your babies, taking care of infants, and various daily activities, they need to ensure their hands are clean too. We need to rope in Accredited Social Health Activist or ASHA workers and Anganwadi workers to promote hygiene as the key driver of good health.

Talking about the need to sustain handwashing practices in India and the challenges with it, Abhishek Sharma, Senior Manager, Research at Sambodhi Research and Communications Private Limited, who has worked extensively on projects covering WASH, livelihoods and child health adds,

In our country, traditional approaches to behavioural change on hand hygiene have been limited to educational messages via awareness campaigns. The research shows that education on health risks associated with poor hand hygiene does not necessarily lead to sustained behaviour change. There are multiple factors associated with handwashing – emotions, habits, settings, infrastructure, poverty, attitude, and lack of will. These prevent the conversion of hygiene-related knowledge into practice and practice into a habit.

Also Read: 77 Per Cent People Changed Their Handwashing Habits Due To COVID-19, Finds A Study By WaterAid India

Malnutrition: The World Health Organization estimates that 50% of cases of child undernutrition across the globe are due to repeated diarrhoea and intestinal infections caused by poor hygiene conditions or lack of safe water. In India, according to the estimates that mapped trends from 2002 to 2017, published in The Lancet on May 12, 2020, 68% of under-5 deaths were reported due to child, maternal malnutrition. WHO states handwashing with soap is a critical determinant for achieving and maintaining good nutrition.

Also Read: POSHAN Maah: Despite Various Government Programmes On Malnutrition, Why Is India Missing Its Nutrition Goals

Dr Shweta Khandelwal, Additional Professor, Public Health Foundation Of India (PHFI) adds,

Good nutrition requires more than access to nutritious foods: it also requires the body to be able to absorb the nutrients in the food a person consumes. If hands are dirty, because of which germs enter human body, they can travel down to the gut. There, they may damage the body’s ability to absorb and use nutrients from food.

Worm Infestation: About 241 million children between the ages 1 – 14 years in India are at risk of parasitic intestinal worms, known as Soil-Transmitted Helminths (STH), according to World Health Organization. That is about 68 per cent or 7 out of 10 children in this age-group are at risk of STH infections. Worm Infestation can be prevented just by improving hand hygiene.

Also Read: Deworming For Children In India: Here Are Five Things To Know

Stressing on the importance of maintaining good hand hygiene Dr Randeep Guleria, AIIMS Director said, “Hand hygiene is the single most important effective thing one can do for a good health and it plays a major role in safeguarding one against any form infections.”

Watch: How Has COVID-19 Affected Handwashing Practices In India?

Cholera: WHO says cholera is an acute diarrhoeal disease that can kill within hours if left untreated. It further states that researchers have estimated that each year there are 1.3 to 4 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to cholera. However, this can easily be prevented if handwashing and good hygiene is implemented.

According to the National Institute of Communicable Diseases, Cholera has been in the endemic stage in India. From 1817 to 1926, the disease had spread worldwide resulting in six pandemics. The seventh pandemic that started in 1961 from Indonesia spread to most of South Asia, Middle East, Africa, Southern Europe and Western Pacific regions. Currently, 447 cholera cases were notified in India in August 2021, according to media reports, and these cases were reported in Baltana, Haryana.

Hepatitis A: According to the Centers For Disease Control and Prevention (CDC), hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. Hepatitis A (HAV) can cause viral infection that can cause liver problems, jaundice, abdominal pain and is often spread via contaminated food prepared by people who have not cleaned their hands properly.

According to US National Library of Medicine National Institutes of Health, Hepatitis A is endemic in India; most of the population is infected asymptomatically in early childhood with life-long immunity. Several outbreaks of Hepatitis A in various parts of India have been recorded in the past decade such that anti-HAV positivity varied from 26 to 85%. Almost 50% of children of ages 1–5 years were found to be susceptible to HAV.

CDC says that practising good hand hygiene—including thoroughly washing hands with soap and water after using the bathroom, changing diapers, and before preparing or eating food—plays an important role in preventing the spread of many illnesses, including hepatitis A.

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.