Graduation Year


Document Type




Degree Granting Department

Civil and Environmental Engineering

Major Professor

James R. Mihelcic


gender, health, Hygiene, Millennium Development Goals, monitoring


Proper hand hygiene is the most effective and efficient method to prevent over 1.3 million deaths annually from diarrheal disease and Acute Respiratory Infections (ARIs). Hand hygiene is also indispensable in achieving the fourth Millennium Development Goal (MDG) to reduce the childhood mortality rate by 2/3rds between 1990 and 2015. Handwashing has been found in a systematic review of studies to reduce diarrhea by 47%#37; and is, thus, capable of preventing a million deaths (Curtis et. al., 2003). Despite this evidence, hand washing rates remain seriously low in the developing world (Scott et al., 2008).

This study developed and implemented a comprehensive monitoring strategy of five usage variables (i.e., soap usage, functionality, presence of cleansing agent, ground wetness under station, amount of water in the jug) for 42-64 appropriate technology handwashing stations. These stations were monitored throughout 2011-2013 in two communities in Mali, West Africa. Statistically significant (p < 0.05) results include: 1) a 29%#37; decrease in soap usage from dry (October-June) to rainy seasons (July-September), 2) 35%#37; decrease in stations with presence of cleansing agent between 2011 and 2012, 3) higher station usage for stations in households with higher scores on the Progress out of Poverty Index® , 4) 27%#37; less of the stations far from a water source (35 meters-172 meters away) had a cleansing agent present than stations close to a water source (less than 35 meters) during the rainy season. Station usage also differed based on gender of the handwashing station owner in the two communities where stations built by women were used more in Zeala than those in Nci'bugu. In contrast to Zeala, handwashing stations built by men in Nci'bugu had higher soap usage and usage variable proportions than those built by women. Handwashing training and promotions resulted in 98%#37; of households reporting that they wash their hands with soap in 2012 from 0%#37; in 2011. Altogether, this study designed and implemented a robust monitoring system that succeeded in quantifying handwashing station usage for over two years. In-depth analysis of the data established six sustainability factors for handwashing stations (gender, training, water, seasonality, wealth, and monitoring) that are critical for lasting handwashing behavior change and successful hygiene interventions to save lives.