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During structured observations of primary caregivers, 1,467 critical events were observed in Peru, 444 in Senegal, and 1,421 in Vietnam. At these critical events, hands were washed with soap in 14 percent of events in Peru, 13 percent in Senegal, and 10 percent in Vietnam. Handwashing with soap was observed during 34 percent of fecal contact events in Peru, 25 percent in Senegal, and 24 percent in Vietnam. In all three countries, caregivers were 1.6 to 3.6 times more likely to be observed washing hands with soap if they lived in homes with observed soap at the handwashing place used after defecation, compared to caregivers living in homes without soap and water at that place. Similarly, caregivers were 2 to 2.4 times more likely to be observed washing hands with soap if soap and water were observed at the place where hands are washed before food preparation. Distance of the handwashing location from either the latrine or the food preparation place was not associated with observed handwashing with soap. Self-reported handwashing was not associated with observed handwashing behavior in multiple countries. In Peru and Vietnam, adjustment for wealth did not alter the associations between the rapid handwashing measures and observed handwashing with soap. In Senegal, none of the rapid handwashing measures were significantly associated with observed handwashing with soap in models including wealth.

This multicountry analysis of the validity of rapid handwashing measures confirms the utility of observing handwashing materials at the places where people wash hands, at the times most necessary for washing them (after …