Water and Handwashing in a Drought-Prone Region of Southern Niger: How Environment, Household Infrastructure, and Exposure to Social and Behavior Change Messages Interact.

This study aims to inform multisectoral development programs by exploring the extent to which social and behavior change (SBC) messages, environment, and household infrastructure are associated with knowledge and practice of handwashing behaviors. A cross-sectional survey of 2,708 households in the Maradi and Zinder districts of Niger was collected in April 2021. Household data were integrated with two local environmental measures: 1) water level at the nearest waterhole point, and 2) anomalous rainfall for the previous rainy season derived from climate hazards infrared precipitation with station rainfall (CHIRPS) data. Logistic regression models were constructed to explore how environment, household infrastructure, and exposure to SBC messages were associated with two hygiene-related outcomes: 1) observed water and soap available at household handwashing stations, a behavior, and 2) knowledge of critical moments for handwashing, a behavioral determinant. We find that in households near a water point with higher water depth, households were statistically significantly more likely (odds ratio [OR] = 1.25); (confidence interval [CI] = 1.12-1.49) to have water and soap observed at the handwashing station. Women in households near a water point with increased water depth (more water) were more likely to know three or more critical handwashing moments (OR = 1.07; CI = 1.03-1.11). Exposure to messages about the importance of handwashing was significantly associated with knowledge of critical handwashing moments and having water and soap observed at a handwashing station. Multisectoral programming should consider layering efforts so that development projects that increase access to water sources are complemented with SBC approaches focused on hygiene.