Hygiene promotions enhance the effectiveness of water and sanitation programme in most of the developing countries . Hygienic behaviors can play an important role in the prevention of diseases related to water and sanitation. An average of 65% of death caused by diarrheal diseases could be reduced if good hygiene practice accompanies the provision of water and sanitation . Diarrheal disease has been considered as a serious global problem  and leading cause of child mortality around the world . Around 2.4 million deaths could be prevented annually by good hygiene practice, reliable sanitation and drinking water . Evidence shows that hand washing can reduce the occurrence of diarrheal diseases by 14-40% . Different studies showed that hand washing can decontaminate hands and prevent cross-transmission [7, 8]. Hand washing with soap can also reduce the risk of endemic diarrhea and respiratory and skin infections . The effectiveness of hand washing with soap can reduce diarrheal risk up to 47% . Many studies carried out in Bangladesh suggested that hand washing is one of the factors which decreases the incidence of diarrhea in intervention areas [11, 12]. Studies also revealed that WASH intervention improve the water, sanitation and hygiene situation in Bangladesh; reduce diarrheal prevalence associated with lower number of fecal-colony forming bacteria on hands .
Bangladesh faces many challenges related to water, sanitation and hygiene. Water and sanitation related disease is considered as one of the most significant child diseases in Bangladesh. Non-fatal chronic conditions such as diarrhea, worm infections, cholera, malaria, trachoma and schistosomiasis are also sourced from water and improper sanitation practice. Water-related diseases are responsible for 24% of all deaths and gastroenteritis and diarrheal diseases killing 110,000 children below the age of five every year in Bangladesh . Improper sanitary practice such as open defecation, lack of proper hand washing practice, fecal disposal in open places are the major risk factors that results in diarrheal or water-borne diseases. Government of Bangladesh (GoB) has taken initiatives to achieve the full coverage of sanitation and in collaborating with BRAC (Bangladesh Rural Advancement Committee) WASH programme to achieve the target of Millennium Development Goal (MDGs).
The overall strategy of BRAC WASH programme is centered on hygiene and behavioral changes. In WASH intervention areas, BRAC form a Village WASH Committee (VWC) with 11 members (6 female and 5 male) from various groups (e.g. local elite, community people) for an average of 200 households. In each VWC, a total of 5–30 clusters were formed consisting of 10 households in each cluster. The programme assistant (PA) organize the cluster meetings ensuring the participation of female members from all 10 households at 2 months interval in each cluster. To ensure the active participation of male, adolescent and children (aged 9–11 years) in WASH activities, the Field Officer (FO) also organizes separate meetings apart from the cluster meetings. The programme also organizes different forums to ensure participation of local elites and other common people. The programme people disseminate knowledge of sanitation and hygienic practices through intensive health education. Besides the BRAC staff, the VWC members, religious leaders, community leaders, school student brigades also take part to implement the programme effectively at community and institutional levels.
To conduct the WASH initiatives in a new village, 3–4 days are needed to disseminate information about WASH and remind the community people of pervious BRAC interventions involving oral rehydration, drinking saline as health measure for diarrhea. BRAC WASH programme is the initial intervention that has undertaken to prevent the spread of diarrhea and other water borne diseases. After the dissemination, BRAC staff members extend an invitation for a cluster meeting in a selected house after consultation with the owner.
During the first day of the meeting, the staff members provide five messages on hand washing to make people aware about hygiene practices: three on hand washing before taking food and two on hand washing after defecation. Along with hygiene education, the health education component consists of awareness building on i) using safe water for cooking, washing and bathing; ii) keeping surroundings of the households, kitchen, tubewells and latrines tidy; iii) construct platform of the tubewells with solid materials; iv) disposal of domestic waste, excreta of poultry and livestock in fixed place and disposal of children’s feces in sanitary latrine. Then a map is drawn on the ground showing all households in the cluster. From that social mapping the availability and location of tubewell and sanitary latrines, water drainage system and the socio-economic system can be portrayed. BRAC-WASH staff members record the community people who have participated to draw the map and demonstrate the hand washing of those members. Then the next day, these people are divided into two groups that walk the whole area of the village and discussed what they have seen and what necessary steps are needed to take to ensure the safe water, sanitation and hygiene facilities for the village people. After the successful completion of the first meeting the committee members fix the place, time and date for the next meeting.
Before launching the WASH programme, a baseline survey was conducted by the Research and Evaluation Division in 2006–2007, to understand the pre-programme status vis-à-vis the impact evaluation of the programme. Subsequently, a midline survey was done during April-July, 2009 to assess the extent of changes occurred in different indicators including knowledge and practices in various intervention components. The aim of the end line survey (December 2009-March 2010) was to identify the impact of BRAC WASH programme on water, sanitation and hygiene practice after five years intervention period.