IT is a small but critical aspect of hygiene that could slowly lead you to your grave. Yet, for most Ugandans, asking one to wash hands upon shaking hands with others and or visiting latrines/ toilets is demeaning, if not, insulting.

Right from the family, through to schools, universities and to work places, Ugandans are, consciously or otherwise, resistant to hand washing, or is it?

The need for hand-washing

Although studies show that the simple act of hand-washing with soap and water at critical times can reduce the occurrence of diarrhea and other water-borne diseases by half as well as reduce the risk of lower respiratory tract infections like pneumonia by up to 23%, this life-saving behavior is not widely practiced, with limited access to latrines/ toilets another challenge.

For example, only one in four Ugandans washes hands properly- with soap and water- after using a latrine/ toilet, explaining why about 75% of the country’s disease burden is preventable and linked to poor hygiene and inadequate sanitation facilities and practices.

It is, therefore, not surprising that Uganda loses about 400 people daily from water-borne infections including, but not limited to; diarrhoea, dysentery, cholera, typhoid, Ebola and Marburg fever, health ministry statistics show.

“Hand-washing is something you don’t have to be told to do,” says Daoud Mukama Mukungu, a public health specialist at the water and environment ministry. “It is one vaccine against most diseases, but many Ugandans avoid it.”

As well, statistics from the Uganda Demographic and Household Survey (UDHS 2005/06) show that 190,000 Ugandan children die every year due to diarrhoea alone. This comes from eating food and other items with contaminated hands.

Global estimates

World-wide, about 3.5 million children die before celebrating their fifth birthday due to diarrheal diseases which can be prevented through effective hand washing practice.

According to Sarah Opendi, the primary health care state minister, most invisible killer diseases, are due to poor hygiene, adding that this could be prevented if people developed a culture of washing hands.

“We are going to enforce a hand hygiene campaign to make sure all our people develop a culture of washing their hands after every activity,” she says.

“We are going to provide alcohol hand rub sanitizers in our hospitals to protect our health workers and patients.”

While the overwhelming majority of households in Sub-Saharan Africa have soap available, many do not use it to wash their hands at critical times- most importantly after using the toilet and before.

Globally, about 2.5 billion people live without access to a toilet, exposing them to risks of catching Diarrhea that results majorly from a lack of toilets and poor hygiene.

For this, the disease has overtaken pneumonia to become the biggest killer of children in Sub-Saharan Africa.

In Uganda, household latrine coverage has, however, improved slowly from 49% when the Kampala Declaration was signed in 1998 to 62% by 2011. This is estimated at 59% presently.

In 2006/07, about 14% of households had access to and used hand washing facilities. This, according to a 2011 survey done by the Uganda Bureau of Statistics (UBOS), rose to 27% up from 13%.

“Apparently, only 28% of the 34m Ugandans have access to hand washing facilities, meaning most Ugandans are susceptible to water-borne diseases,” says Mukungu.

“This is a serious health and economic problem because when someone is ill due to diarrhoea, even their productivity falls, affecting the economy.”

Dr. Elizabeth Kukunda Bacwayo, an associate professor in the faculty of social sciences at Uganda Christian University, says only 51% of Ugandans have access to public taps provided by government agencies whilst only 1.5% access public taps in rural areas.

As well, only 8% of urban areas have access to piped sewerage, with 92% using on-site system latrines.

“Water contamination is high in Uganda,” notes Bacwayo. “I lived in Australia and I got water from the tap and drunk. In Uganda, you still have to boil pipe water, meaning it is not clean and safe!”

Challenges

Poor harnessing of rain-water that results in floods during times of plenty and drought when the rains stop, increase in overheads due to increasing number of districts, limited resources, cheaper technology and poor water harvesting techniques, are responsible for poor safe water coverage.

“More importantly, most Ugandans just don’t value hand-washing,” says Mukungu. “Many think it is an inconvenience while others are just adamant because they were not trained to wash their hands after using latrines.”

As well, water supply in homes is a reserve of children and women in most Ugandan homes. On average, children and women spend a minimum of 30 minutes in trekking two kilometres to the nearest water source in Uganda.

“This weakens their spines at early age and exposes them to risks of sexual harassment,” says Zac Mulawa, a researcher. “There is need to bring water closer to children and women.”