Wealthiest Households’ Handwashing Places Lack Soap in Bangladesh: An Observed, Cross-Sectional Data Analysis

Abstract

Background: A large percentage of the wealthiest households in Bangladesh lack soap at their handwashing places, which is typically considered a problem of the poor. We sought to investigate toilet-sharing and water source along with sociodemographic characteristics as factors associated with the handwashing places missing soap in the wealthiest households of Bangladesh. Methods: Data for the study came from the 2014 Bangladesh Demographic and Health Survey (BDHS) of 17300 nationally representative households. One thousand seven hundred fifty-seven (10.2%) of the households categorized in the ninth wealth decile reporting on handwashing places with or without soap were used for analysis. We used both exploratory and logistic regression analyses accounting for survey design and adjusted for sex, age, place of residence, and region to investigate how selected factors were associated with observed handwashing places without soap. Findings: We found that 40.7% (95% CI: 0.36–0.46) of the wealthiest households were observed to have no soap in their handwashing places. Of these households, those who shared their toilets with another household were 6.4 times (95% CI: 4.41–9.16; p < 0.001) more likely to have handwashing places without soap as compared with those who did not share their toilets. If they shared their toilet with more than nine households, they were 10.1 times (95% CI: 4.65–21.82; p < 0.001) more likely to have handwashing places without soap than those who did not share their toilets. Also, the wealthiest households were 4 times (95% CI: 2.22–7.25; p < 0.001) more likely to have handwashing places without soap if they collected water from their own yard, and 4.7 times (95% CI: 2.38–9.35; p < 0.001) more likely to have handwashing placed with soap if they collected water from other dwellings in comparison to the reference group that collected water from their own dwelling. Water-fetching time was not statistically significant in our analysis. Interpretation: Bangladesh has the largest number of households having handwashing places without soap in South Asian countries. Factors like toilet-sharing and water source location along with sociodemographic characteristics can explain this “no soap” observation. Cross-examined and self-reported data along with observed data on handwashing and sanitation practice–related questions are essential to understand a household’s actual soap-keeping and usage. Our study demonstrates how data from household-specific health programs can be used to inform all-inclusive hygiene initiatives coupled with sanitation policies to improve public health.