Handwashing and mask wearing during COVID-19 in water insecure communities in Chiang Mai

Handwashing and wearing mask are first line defense for protecting yourself and others from (the virulent transmissions) of COVID-19 (CDC). Campaigns to increase adoption of these prevention behaviors have been widespread and relatively successful among the general population in Thailand during the initial waves of COVID-19. Though the extent to which vulnerable or marginalize people have adopted such practices has been less reported.

Boripat Lebel By Boripat Lebel - Jul 23, 2021

As part of the SUMERNET-funded project “Listening to voices on the margins: lessons from the COVID-19 crisis for improving access to clean water for drinking and hygiene in the Mekong Region” (nicknamed VOICES), a survey of approximately 300 respondents in 3 districts across Chiang Mai, Thailand was carried out between January to April 2021. Participants included ethnic minority communities in Mae Wang District (upland), construction camp workers in San Sai District (lowland), and informal settlement dwellers in Mueang District (urban). A range of questions were asked in the survey relating to impacts of COVID-19 on water insecurity. However, this article will focus on the results relating to the COVID-19 prevention measures adopted by the respondents, in particular, handwashing and wearing mask.

From the survey, most respondents (35%) washed their hands at least 6-10 times per day. Half of the respondents (53%) spent 10-30 seconds per handwash, and a quarter (25.8%) spent over 30 seconds per wash. When asked about the situations in which they would usually wash their hands, almost all respondents (99%) agreed with the following statements: before eating meals, after eating meals, after going to the toilet, or whenever they look dirty. Only 71% of respondents said they would wash hands before touching sick people, increasing to 83% after touching sick people.

When asked if the COVID-19 outbreak changed their handwashing behavior compared to before the outbreak, almost all respondents (95% or greater) agreed that they: wash hands more thoroughly, wash hands more frequently, use soap more frequently, and wash hands in more situations. Many (82.5%) also noted that they use hand sanitizer more frequently.

In regard to masks, most (95%) reported using disposable masks with some overlap of using reusable cloth masks (53%). Almost all respondents (98% or greater) agreed that since the beginning of last year (2020) until now they would put on face masks in the following situations: before entering crowded places, before meeting and talking with strangers, whenever leave home, or when air quality was poor. Slightly less (87%) would wear mask before going near sick people, and even less so (77%) before approaching very old people.

When asked how the COVID-19 outbreak has impacted their mask wearing, almost all respondents noted that they wore a mask more often outside the home (99.7%) and changed masks more frequently (97%). Only a third (33%) said that they wore a mask more often at home.

From the findings, most respondents washed their hands within a time range recommended by the CDC, at least 20 seconds with soap (CDC). Situations in which respondents would wash their hands correspond with cultural norms, such as before and after eating meals or after going to the toilet. The slightly lower response to washing hands before touching sick people is perhaps at first surprising, but one reason could be that people use hand sanitizers instead, which they carry around on them, and are also readily available inside hospitals. This is in concurrence with another related finding where respondents noted increased use of hand sanitizers.  

In regard to mask use, from findings it is evident that respondents wear mask more frequently when doing activities outside the house, though less so when inside their own home, where they may perceive less risk of infection of COVID-19. This may explain the slightly less response to wearing mask in the situation of before approaching very old people.

An important limitation was that when addressing handwashing, it was not specified clearly in the survey questionnaire whether this activity included soap. Further studies should take this into consideration.

Adoption of handwashing and mask wearing during COVID-19 among vulnerable people in Chiang Mai were relatively high. Further campaigns or messaging in public health may want to focus on handwashing with soap or use of hand sanitizer before and after coming into contact with a sick person, as well as guidelines on the duration a mask should be worn before being replaced or washed. By the same token, campaigns or messaging related to handwashing may need to be tailored, taking into account water access of that location, since efforts to increase handwashing frequency or duration could inadvertently increase issues relating to water insecurity.   

Supplementary materials

Figure 1. Results from the survey question “How many times per day do you wash your hands?”

Figure 2. Results from the survey question “How long do you spend washing your hands each time?”

Table 1. Results from survey question “Do you usually wash your hands in these situations?”

Table 2. Results from survey question “At any time, did the COVID-19 outbreak have any of the following impacts on your handwashing behavior (compared to before outbreak)?”

Table 3. Results from survey question “Since the beginning of last year until now, did you usually put on a face mask in these situations?”

Table 4. Results from survey question “Did the COVID-19 outbreak have any of the following impacts on you wearing and washing masks?”

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