The year 2008 was designated as the International Year of Sanitation by the UN General Assembly. In the same year UNICEF declared 15th October as Global Handwashing Day to echo and reinforce the call for improved hygiene practices. The annual observance of the day was launched in 2008 as an initiative of the Global Public-Private Partnership for Handwashing with Soap. It is endorsed by a wide array of governments, international institutions, civil society organizations, non-governmental organizations, private companies and individuals worldwide. This annual celebration of Global Handwashing Day is designed to:

l Foster and support a glo bal and local culture of handwashing with soap

l Raise awareness about the benefits of handwashing with soap.

l Shine a spotlight on the state of handwashing in each country.

During the first ever Global Handwashing Day in 2008, over 80 countries participated in handwashing day activities, with about 200 million children washing their hands with soap and water at public events. Activities ranged from school assemblies and contests to government outreach programmes, SMS text messaging campaigns, photo exhibits and celebrity appearances.

The Global Handwashing Day revolves around schools and children. Children suffer disproportionately from diarrheal and respiratory diseases and deaths. But experience revealed that children - the segment of society so often the most energetic, enthusiastic and open to new ideas - can also be part of the solution. Ideally situated at the intersection of the home, school and community, children can be powerful agents of behavioral change.

The guiding vision of Global Hand washing Day is a local and global culture of hand washing with soap. Handwashing is the cornerstone of public health. A recent study in Nepal examining the relationship between hand washing practices and neonatal death demonstrated the strong positive effect that maternal and birth attendant hand washing had on lowering neonatal mortality. Birth attendant hand washing resulted in a 25% lower risk of death compared with those who did not wash hands. Similarly, newborns had a 60% lower risk of death when mothers reported washing their hands before handling the baby sometimes or always.

Fundamental Five: Five Facts about handwashing with Soap

1. Washing hands with water alone is not enough!

People around the world wash their hands with water. It is usually believed that washing with water alone to remove the visible dirt is sufficient to make hands clean. But washing hands with water alone is significantly less effective than washing hands with soap in terms of removing germs, and handwashing with soap is seldom practiced. Around the world, the observed rates of handwashing with soap at critical moments (such as before handling food, after using toilet or while cleaning a child.) range from zero percent to 34 percent. Proper handwashing requires soap and only a small amount of water. Using soap works by breaking down the grease and dirt that carry most germs, facilitating the rubbing and friction that dislodge them and leaving hands smelling pleasant. The clean smell and feeling that soap creates are incentives for its use. With proper use, all soaps are equally effective in rinsing away the germs that cause disease.

2. Handwashing with soap can prevent diseases that kill millions of children every year.

Handwashing with soap is among the most effective and inexpensive ways to prevent diarrheal diseases and pneumonia, which together are responsible for the majority of child deaths. Every year, more than 3.5 million children do not live to celebrate their fifth birthday because of diarrhea and pneumonia. Handwashing can also prevent skin infections, eye infections, intestinal worms, SARS, Avian Flu, Swine flu, and benefits the health of people living with HIV/AIDS.

3. The critical moments for handwashing with soap are after using the toilet or cleaning a child and before handling food.

Hands should be washed with soap after using the toilet, after cleaning a child's bottom (or any other contact with human excreta, including that of babies and children) and before any contact with food. Hands are the principal carriers of disease-causing germs.

It is important to wash your hands at key times, i.e before Eating, Touching Food, Cooking,Handling clean/treated water and after Going to the toilet, Handling raw food, Disposing of child's faeces

We must remember: Our Health is in Our Hands!

4. Handwashing with soap is the single most cost-effective health intervention:

Handwashing with soap is the single-most cost-effective health intervention. Disability-adjusted life years (DALYs) are used to measure the burden of disease and the effectiveness of health interventions by combining information on years of life lost and

years lived with a disability. Remarkably, handwashing with soap has been shown to be the most effective way to avert DALYs associated with diarrheal diseases. Handwashing is also orders of magnitude less expensive than immunization; Soap is already available in most households in the world; cost is not the chief barrier to handwashing with soap, it is the mindset and practice.

Handwashing promotion is cost-effective when compared with other frequently funded health interventions. A $3.35 investment in handwashing brings the same health benefits as an $11.00 investment in latrine construction, a $200.00 investment in household water supply and an investment of thousands of dollars in immunization. Investments in the promotion of handwashing with soap can also maximize the health benefits of investments in water supply and sanitation infrastructure and reduce health risks when families do not have access to basic sanitation and water supply services. Cost is not typically a barrier to handwashing promotion; almost all households in the world already have soap - though it is commonly used for laundry, dish washing and bathing rather than for handwashing.

5. Social marketing approaches that center on the potential handwasher and his or her specific motivations are more effective than traditional disease-focused approaches.

Research shows that handwashing behavior can be changed on a large scale through the use of social marketing approaches. The key is to view the potential handwasher as a consumer and then research that consumer's handwashing habits, as well as the factors that might encourage him or her to adopt new handwashing behaviors; design appropriate messages that appeal to the consumer's needs, wishes and preferences; and implement promotion programs that make use of a variety of message delivery channels.

Now a question may arise - what about people who don't have access to soap? Lack of soap is not a significant barrier to handwashing at home. The vast majority of even poor households have soap in their homes. Research in periurban and rural areas found, for instance, that soap was present in 95 percent of households in Uganda, 97 percent of households in Kenya and 100 percent of households in Peru. The problem is that soap is rarely used for handwashing. Laundry, bathing and washing dishes are seen as the priorities. Though we do not have such studies in Bangladesh but we have seen people using soap for bathing and laundry purpose. Lack of soap can be a barrier to handwashing at schools as schools in developing countries often have neither soap nor appropriate handwashing facilities. Special measures may be taken to ensure supply of water and soap in school with nominal investment. The role of public-private partnership in this regard is crucial.

It was also found that handwashing can make a difference in overcrowded, highly contaminated slum environments? A study in Karachi, Pakistan, found that children in communities that received intensive handwashing interventions were half as likely to get diarrhea or pneumonia as children in similar communities that did not receive the intervention.

It is interesting to see that lack of hand-washing with soap is not a problem only in developing countries! Even in developed countries where handwashing is a (comparatively) entrenched practice and both soap and water are plentiful, people often fail to wash their hands with soap. A study in England found that people washed their hands only about half the time after cleaning a child after defecation.

Proper handwashing requires soap and only a small amount of water. Running water from a tap is not needed; a small basin of water or "Tippy Tap" is sufficient. (Tippy Taps are cans or plastic bottles that release a small amount of water - just enough for a clean hand wash - each time they are tipped.) One should cover wet hands with soap; scrub all surfaces of hands, including palms, back, between the fingers and especially under the fingernails, for at least 20 seconds; rinse well with running water (rather than rinsing in still water); and dry either on a clean cloth or by waving in the air.

Handwashing with soap is a life-saving intervention within the technological and financial reach of all countries and communities. But promoting it requires appeals not necessarily to health, but to other things that people value, such as comfort, social status, nurture and a wish to avoid disgust. Effective promotion requires understanding behaviors and motivations for change. Let us look at how we can change people's handwashing behaviors.

Practitioners in the water supply, sanitation and hygiene sector, as well as manufacturers of soap, have learned a great deal about what works - and what doesn't - in changing private, personal behaviors and habits. What doesn't work is top-down, technology-led solutions or campaigns that hinge on health education messages. What is more effective is using approaches that build on the lessons of social marketing. This new approach emphasizes the role of careful formative research (a thorough study of the interests, attributes, needs and motivations of different people within a community. The new programs seek to reach and influence their target audiences through multiple mass media and interpersonal communication channels with specific messages designed to respond to their expressed needs and preferences. In short, treating people not as passive project beneficiaries but rather as active customers motivated by a diverse range of preferences and motivations yields best results.

There is much to be learned from successful interventions in other sectors. Evidence shows that Reproductive health programs that pay attention to consumer needs and preferences work better than those that impose top-down targets. Similarly, approaches that create incentives for positive provider attitudes and behaviors get better results than those that rely on targets and punitive management practices. Successful sanitation programs generate community demand for toilets and latrines by appealing to people's desires for status, acceptance, community solidarity, privacy, convenience, safety and comfort; appeals to health tend to be significantly less effective in motivating behavioral change. The non-health motivations can be compared to the reasons people try to lose weight; maintaining a healthy weight is very important to one's health - but the reason people go on diets is generally not to be healthier but rather to look better.

Different communities value and are motivated by different things; there is no "one size fits all" handwashing campaign. For instance, formative research in Kerala, India, suggests that people want clean hands for reasons of comfort, to remove smells, to demonstrate love for children and to exercise their social responsibility. In Ghana, a study found the chief motives for handwashing to be to nurture, to avoid disgust and to gain social status. Social marketing campaigns that are based on the hopes and desires of the target population and approach that population as consumers with a range of behavior choices have found far more success than conventional promotion campaigns based on what experts believe a target population should do.

So, let us start working. In the long term we hope, Global Handwashing Day will become a powerful platform for advocacy aimed at policy makers and key stakeholders and an occasion for concrete public commitment to actions that will encourage handwashing with soap among all sections of people.

[Information used in this article was gathered from different websites.

Dr. A Z M Zahidur Rahman works for Social Marketing Company.

Cancer arises when certain cells within a given tissue grow abnormally forming a mass called tumour, spread to other sites away from the parent tissue and replicate frequently. Tumours can be benign remaining within the tissue of origin, in which case the growth is not cancer, and malignant, in which case the growth is cancer. According to a report, about 1500 people die of cancer in the US everyday.

Cancers can occur in almost any tissue, such as the lung, colon, breast and skin. They are classified into 4 major groups: Carcinoma, Sarcoma, Leukaemia and Lymphoma. Breast Cancer, Kidney (Rental Cell) Cancer, Leukemia, Lung Cancer, Prostate Cancer, and Thyroid Cancer are some of the common types. Incidence of cancer is very high among people over 60 years old.

Genetics play an important role in causing cancer. However, some viruses, radiation, sunlight and tobacco are known to be among other causes. Lung cancer is the most common cause of cancer-related death.

Symptoms of cancer may include blood in the stool, loss of appetite, fatigue, fever, chest pain and chills. However, in some cases there may not be any apparent symptoms at all. Generally, biopsy is done to diagnose cancer. Chest x-ray, complete blood count (CBC) and CT scan are among other common diagnostic methods.

Tumours that have not metastasized are normally treated with surgery or radiotherapy while tumours that have already disseminated require systematic treatment with chemotherapy or hormonal therapy. The problem with radiotherapy and chemotherapy is they both act by causing damage to DNA (both tumour cells and normal cells). So it is necessary to carry out specialized investigations to determine the extent of dissemination of the tumour before deciding on treatment.

The development of cytotoxic drugs is also making it possible for physicians to manage malignancy. Meanwhile, theories are being put forward about effectiveness of certain herbs like Graviola and spices in combating cancer. Besides treatment, what is of utmost importance for a cancer patient is the strong determination to live.

ET Health Desk