Hygiene in Lower Income Countries

Overview of Hygiene in Lower Income Countries

Hygiene refers to acts that can lead to good health and cleanliness, such as frequent handwashing, face washing, and bathing with soap and water. Keeping hands clean is one of the most important ways to prevent the spread of infection and illness. However, in many areas of the world, practicing personal hygiene is difficult due to lack of resources such as clean water and soap. Many diseases (including diarrheal diseases) can be spread when hands, face, and body are not washed appropriately at the key times.

In many lower income countries, diarrheal disease is the leading cause of death among children. However, a recent review of data from a number of studies showed that a 42%-47% reduction in diarrhea can occur when handwashing with soap and water is introduced into a community. Thus, handwashing promotion and interventions are estimated to have the potential to prevent one million deaths from diarrheal diseases 1.

Most diarrheal diseases are spread by person-to-person contact or by fecal-oral routes, many times by way of contaminated hands. Handwashing can stop the spread of many diarrheal disease-causing germs, such as typhoid and cholera, by removing bacteria, parasites, and viruses from the hands. Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of lower income countries. This lack of access is one of many challenges to proper hygiene in lower income countries. Effective handwashing interventions involve education and promoting long-term behavior changes, both in appropriate social and cultural contexts.

For more information on handwashing, visit CDC’s Keeping Hands Clean and Handwashing: Clean Hands Save Lives pages.

For a listing of other, potentially-waterborne diarrheal disease and further information, visit CDC’s Index of Water-Related Topics.

  1. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhea risk in the community: A systematic review.External Lancet Infect Dis. 2003;3(5):275-81.

A number of challenges and barriers to good hygiene exist in lower income countries. The greatest of these challenges is the lack of clean water. Hundreds of millions of people do not have access to improved sources of drinking water 1; worldwide, there are 1.6 million deaths per year attributed to diseases spread through unsafe water, poor sanitation, and lack of hygiene 2.

However, even under circumstances where clean water is not available, evidence indicates that hygiene practices (for example, washing hands) using unsafe water are beneficial to reducing the spread of disease and are better than not washing at all. When access to safe water is poor, the Centers for Disease Control and Prevention (CDC) recommends using unsafe water in the same manner as safe water for hygiene practices, to clean hands before eating, after using the toilet, and at other key times.

In addition to water, another hygiene challenge in lower income countries is access to soap. Even when soap is available, it is typically used for laundry and bathing instead of for handwashing. A number of international programs focus on teaching the importance of using soap to wash hands.

One innovation designed to provide a simple, economical, and effective hand-washing station to communities in lower income countries is the tippy tap. Cdc-pdf[PDF – 2 pages] These devices use significantly less soap and water than other, traditional means of handwashing. In water-scarce settings, CDC’s Safe Water System (SWS) employs the use of tippy taps for handwashing. The SWS is a systematic intervention to improve water quality and access in lower income countries. This intervention consists of three steps:

  1. Point-of-use treatment, in which contaminated water is treated
  2. Safe water storage, which involves the use of specially designed containers
  3. Behavior change techniques, including activities to increase awareness and encourage good hygiene practices

These types of programs, designed to provide education about and access to safe water, are integral to the improvement of water resources in these areas; however, hygiene challenges remain a significant problem for millions of people living in lower income countries.

  1. World Health Organization and UNICEF. Progress on drinking water and sanitation – Special focus on sanitation.External 2008.
  2. United Nations Millennium Project. Health, dignity, and development: What will it take? Cdc-pdf[PDF – 228 pages]External 2005.

Many diseases and conditions can be prevented and/or controlled through proper personal hygiene by:

  • Washing hands with soap and running water (if available):
    • Before, during, and after preparing food
    • Before eating food
    • Before and after caring for someone who is sick
    • Before and after treating a cut or wound
    • After using the toilet
    • After changing diapers or cleaning up a child who has used the toilet
    • After blowing your nose, coughing, or sneezing
    • After touching an animal, animal feed, or animal waste
    • After handling pet food or pet treats
    • After touching garbage
  • Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others. Many diseases and conditions are spread by not washing hands with soap and clean, running water. If clean, running water is not accessible, as is common in many parts of the world, use soap and available water. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands.
  • Cleaning teeth regularly with toothpaste, a toothbrush, and safe water (preferably clean, running water if available).
  • Frequently washing other parts of the body and hair with soap and running water (if available):
    • Trachoma infection can be prevented through increased facial cleanliness using soap and water, and improved sanitation to reduce fly breeding sites.
    • People with lymphatic filariasis can prevent secondary bacterial and fungal infections and decrease the risk of lymphedema progression to elephantiasis by daily washing of the swollen area (usually the limbs) with soap and water, as well as disinfecting wounds with antibacterial or antifungal cream.

For more information on the appropriate steps for handwashing and how handwashing can save lives, visit CDC’s Handwashing: Clean Hands Save Lives and CDC Features: Wash Your Hands.

For more information on Global Water, Sanitation, and Hygiene (WASH-related) diseases, visit CDC’s Healthy Water Global WASH-related diseases.

Hand sanitizers should primarily be used as an optional follow-up to traditional handwashing with soap and water, except in situations where soap and water are not available. In those instances, use of an alcohol-based product containing at least 60% alcohol 1 is recommended.

When using an alcohol-based hand rub:

Washing hands with soap and water is the best way to reduce the number of microbes on them in most situations. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs.

Hand sanitizers are not as effective when hands are visibly dirty or greasy.

How do you use hand sanitizers?

  • Apply the product to the palm of one hand (read the label to learn the correct amount).
  • Rub your hands together.
  • Rub the product over all surfaces of your hands and fingers until your hands are dry.

magnifying glassWhy? Read the science behind the recommendations.

  1. CDC. Guidelines for hand-hygiene in healthcare settings: Recommendation of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Cdc-pdf[PDF – 56 pages] 2002.
Page last reviewed: July 26, 2016