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Hygiene, Hand Washing, Clean Water and Sanitation

Safe drinking water is essential to good health. But in resource-poor settings, water often comes from unsafe sources and carries deadly pathogens. Of the nearly two million deaths from diarrheal disease each year, many are due to an unsafe water supply. PATH’s Safe Water Project is testing commercial market approaches for household water treatment and safe storage products in Andhra Pradesh, India, learning about bridging the gap in the distribution of products to developing-country poor. The project focuses on working with partners to build distribution channels, improve existing products to make them more appropriate for low-income settings, and learn about generating demand to sustain correct use and purchase decisions. Ultimately, the project will provide strategies and tools for scale-up, replication, and sustainability for a range of settings. Research on the water treatment market, products, and behaviors is also being conducted in Vietnam, Cambodia, Ghana, Tanzania, and Kenya to support these strategies and tools. More information is available on the PATH website. UNICEF collaborates with partners, families, and communities in more than 90 countries to improve water supply and sanitation, promote safe hygiene practices, and give urgent relief in response to disrupted water supplies and waterborne diseases.

UNICEF: Syrian children sing their way to better health and hygiene

Key resources

Below are some key documents on handwashing, clean water, and sanitation. Please also visit our partners’ websites for more resources.

Other helpful websites

1 United Nations Millennium Development Goals.

PATH/JVG Krishnamurthy.

Reproduced from the PATH Resources for Diarrheal Disease Control website at www.eddcontrol.org, [6 November, 2009].

Why it is important to share and act on information about Hygiene More than half of all illnesses and deaths among young children are caused by germs that get into their mouths through food or water or dirty hands. Many of these germs come from human and animal faeces. Many illnesses, especially diarrhoea, can be prevented by good hygiene practices: putting all faeces in a toilet or latrine; washing hands with soap and water or ash and water after defecating or handling children's faeces, and before feeding children or touching food; and ensuring that animal faeces are kept away from the house, paths, wells and children's play areas. Everyone in the community needs to work together to build and use toilets and latrines, protect water sources, and safely dispose of waste water and garbage. It is important for governments to support communities by providing information on low-cost latrines and toilet facilities that all families can afford. In urban areas, government support is needed for low-cost sanitation and drainage systems, improved drinking water supply, and garbage collection.
What every family and community has a right to know about Hygiene

Hygiene On-line Resources

A complete and up-to-date list of the following and related resources can be found at
Enhanced Diarrheal Disease Control Resource Center

Effect of washing hands with soap on diarrhoea risk in the community: A systematic review (abstract only; 2003)
Through a systematic review, the authors found that washing hands with soap can reduce the risk of diarrheal diseases by up to 47 percent and hand-washing promotion could save one million lives. The review also calls for more and better-designed trials to further measure the impact of hand-washing on diarrhea and acute respiratory infections in developing countries.
Curtis V, Cairncross S. Lancet. 3(5):275-281.
Clean hands reduce the burden of disease (2005)
This commentary describes the complexities of hand-washing promotion among low-resource communities, in reference to a study conducted in Pakistan that found a reduction in infectious disease incidence, including diarrheal episodes, through application of hand-hygiene education and resources.
Pittet D. Lancet. 366(9841):185–186.
Clean hands reduce the burden of disease (2005)pdf 365 kb
The handwashing handbook: A guide for developing a hygiene promotion program to increase handwashing with soap (2005)
This guide was created for public health staff working to implement community hand-washing programs and decision-makers developing public health policy on hygiene practices.
World Bank
The handwashing handbook: A guide for developing a hygiene promotion program to increase handwashing with soap (2005)pdf English 1.57 mb
Health, dignity and development: What will it take? (2005)
With respect to achieving the Millennium Development Goals, this report focuses on the necessary steps and potential impact of expanding and sustaining water supply and sanitation coverage
World Health Organization (WHO) Millennium Project Task Force on Water and Sanitation
Health, dignity and development: What will it take? (2005)pdf English 1.71 mb

General information

Global water supply and sanitation assessment report (2000)
The report provides a global overview of water supply and sanitation.
WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation
Health in Your Hands: The global public-private partnership for handwashing with soap
This collaboration of international organizations promotes handwashing with soap as an intervention to reduce the incidence of diarrheal disease in poor communities. Resources on this website include lessons learned, behavior studies, public service announcements, and much more.
Water Supply and Sanitation Division
World Bank
This website provides information about World Bank activities addressing water and sanitation strategy and policies. Activities are categorized by topic and/or region.
Water Supply, Sanitation and Hygiene Development Division
This division of WHO performs activities and provides guidance toward sanitation improvement and enhanced hygiene practices.
Water and health in Mali (2006)
This case study from the UN’s World Water Development Report 2006 provides an overview of health challenges faced by a lack of clean water in poor communities in Mali and outlines efforts to address them.
United Nations (UN)
Water and health in Mali (2006)pdf English 251 Kb


PHAST step-by-step guide: A participatory approach for the control of diarrhoeal diseases (1998)
This manual was developed through the work of Participatory Hygiene and Sanitation Transformation, a collaboration between WHO and the UN, and aims to guide community interventions through the development of a plan to prevent diarrheal diseases by improving water supply, hygiene behaviors, and sanitation.
WHO (WHO/EOS/98.3)


Evaluation of the costs and benefits of water and sanitation at the global level (2004)
The aim of this study was to estimate the economic costs and benefits of selected interventions toward water and sanitation improvement. The document presents both regional and global analyses.
A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home (abstract only; 2005)
This study analyzed the use of hand sanitizer and hygiene education among families who have at least one child enrolled in out-of-home care and found that transmission of illness was reduced when interventions with alcohol-based sanitizer and multifaceted education messages were introduced.
Sandora T, et al. Pediatrics. 116(3):587–594.
Effect of Intensive Handwashing Promotion on Childhood Diarrhea in High-Risk Communities in Pakistan (2004)
This study implemented handwashing interventions with plain and antibacterial soap and found that diarrhea incidence was reduced among children of ages ranging from infancy to 15 years.
Luby S, Agboatwalla M, Painter J, Altaf A, Billhimer W, Hoekstra R. Journal of the American Medical Association; 291(21):2547–2554.
Handwashing-related research findings (1998)
This summary provides statistics on hand-washing practices in the US, as reported and observed through the Handwashing Observational and Telephone Survey conducted for the Bayer Corporation Pharmaceutical Division in association with the American Society for Microbiology.
US Food and Drug Administration
Water, sanitation and hygiene: Interventions and diarrhoea - A systematic review and meta-analysis (2004)
This paper offers a review of studies in developing countries, as well as in established market economies, that assessed the public health impact of specific interventions in water quality, water supply, hygiene, and sanitation.
Fewtrell L, Colford J. World Bank
Water, sanitation and hygiene: Interventions and diarrhoea - A systematic review and meta-analysis (2004)pdf English 1 mb
Reported measures of hygiene and incidence rates for hospital-acquired diarrhea in 31 French pediatric wards: Is there any relationship? (2003)
This study evaluated simple hygienic measures for reducing hospital-acquired diarrhea.
Jusot J, Vanhems P, Benzait F, et al. Infection Control and Hospital Epidemiology. 24(7):520–525.
Reported measures of hygiene and incidence rates for hospital-acquired diarrhea in 31 French pediatric wards: Is there any relationship? (2003)pdf English 136 kb

updated: 23 August, 2019