Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions

Fosiul A. Nizame The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Elli Leontsini Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Stephen P. Luby Stanford University, Stanford, California.

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Md. Nuruzzaman The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Shahana Parveen The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Peter J. Winch Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Pavani K. Ram University at Buffalo, State University of New York, Buffalo, New York.

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Leanne Unicomb The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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This study explored the steps of food preparation, related handwashing opportunities, current practices, and community perceptions regarding foods at high-risk of contamination such as mashed foods and salads. In three rural Bangladeshi villages, we collected qualitative and observational data. Food preparation was a complex and multistep process. Food preparation was interrupted by tasks that could contaminate the preparers' hands, after which they continued food preparation without washing hands. Community members typically ate hand-mixed, uncooked mashed food and salad as accompaniments to curry and rice at meals. Hand-mixed dried foods were mostly consumed as a snack. Observers recorded handwashing during preparation of these foods. Among 24 observed caregivers, of 85 opportunities to wash hands with soap during food preparation, washing hands with soap occurred twice, both times after cutting fish, whereas washing hands with water alone was common. A simple and feasible approach is promotion of handwashing with soap upon entering and re-entering the food preparation area, and ensuring that everything needed for handwashing should be within easy reach.

Author Notes

* Address correspondence to Fosiul A. Nizame, Environmental Intervention Unit, The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. E-mail: fosiul@icddrb.org

Financial support: The study was funded by the Bill & Melinda Gates Foundation.

Authors' addresses: Fosiul A. Nizame, Md. Nuruzzaman, Shahana Parveen, and Leanne Unicomb, Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh, E-mails: fosiul@icddrb.org, nuruzzaman@icddrb.org, shahana@icddrb.org, and leanne@icddrb.org. Elli Leontsini and Peter J. Winch, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: eleontsi@jhu.edu and pwinch@jhu.edu. Stephen P. Luby, Woods Institute of the Environment, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu. Pavani K. Ram, University at Buffalo, State University of New York, Buffalo, NY, E-mail: pkram@buffalo.edu.

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