Though, not on the sanitation side, attached is a paper, circulated by Sandec, on using
plant xylem from the sapwood of coniferous trees, for water filtration.

Yes, that is true. My review was in connection with the use of soap. What I mentioned about the experience in Sindh, is not backed by any research, but is just a 60 years old tradition, that still continues this day.

There is not much research on the use of ash or mud. However, I’m attaching one with post, which is: Use of ash and mud for handwashing in low income communities.

I’m also attaching a 6-page brochure on Handwashing Behaviour in Bangladesh. It mentions use of ash.
A 2-page flyer on Handwashing in a Disaster, attached, also has reference to ash.

The abstract of a paper, A comparison of local handwashing agents in Bangladesh, Hoque BA, Briend A, J Trop Med Hyg. 1991 Feb;94(1):61-4, reads:

The efficacy of handwashing using ash, soap, mud or plain water was tested in a group of 20 women living in a slum of Dhaka in Bangladesh. Each woman was asked to wash her hands using each of the washing agents and the efficacy of handwashing was assessed by comparing estimated faecal coliform counts from post-washing hand samples. Mud and ash were found to be as efficient as soap. Research on appropriate handwashing techniques in the light of the existing practices is suggested.

Thank you,

F H Mughal

Thank you, that is interesting. Can I just clarify that the review of which you speak was concerned with washing with soap and water rather than ash?

I remain unconvinced about the overall benefits of handwashing. The reports I have seen, particularly those by Cairncross et al. tend to be review articles based on a lot of studies. The problem there is when it is claimed that x infections could be prevented by handwashing - as far as I can see, they have never been able to adequately control for the quality of handwashing water in these review studies, which one would think must have an impact on the effectiveness of handwashing.

Of course, it makes total sense that handwashing has an impact. But if one is going to advocate handwashing, presumably first you have to be sure of a clean source of water with which to wash the hands.

Random use of local ash seems to me to be unlikely to be as good as washing hands with clean water and soap, but I don't recall reading specific research on this.

In the rural areas of Sindh, Pakistan, people, who resort to OD – open defecation (OD is common in the rural areas here), use ash or topsoil (whatever is available at the defecation spot) to clean their hand. The practice of using ash is in vogue here, in the rural areas, for the last many decades.

Apart from ash, two important adjuncts are the vigorous rubbing and scrubbing between fingers and fingernails, and the handwashing time.

I researched on an appropriate handwashing time by looking at many resources (WHO, UNICEF, US Centers for Disease Control and Prevention, Australian healthcare, Canadian healthcare, Minnesota Department of Health, Food Safety Authority of Ireland, The Global Public-Private Partnership for Handwashing with Soap, Health Education to Villages, and a personal communication with a London-based institution). The review showed that while the handwashing time varies from 10 to 60 seconds, the most advocated handwashing time was found to be 15 to 20 seconds. And, in most cases, it was advocated that if the hands are visibly soiled, ingrained with dirt, or oiled, the handwashing time should be appropriately (based on common-sense) increased.

The handwashing time of 15 to 20 seconds would apply when toilets are used, before cooking food and, before eating food.

After handwashing, it is important that the hands must be dried with a clean towel, or if clean towel is not available, air-dried by waving in the air. If the hands are not dried, the wet hands will get contaminated again with germs. This point may be hard to swallow, but it is a bold fact.

F. H. Mughal

Incidentally, I notice that Sandy Cairncross is one of the authors of the paper which the original post in this thread refers to.

dietvorst wrote: Manufacturers like to make us think that soap is essential
A colleague of mine told me once that the London School of Hygiene & Tropical Medicine had come to a similar conclusion - though I can't find the reference.

That'll be the work by Sandy Cairncross and co who have been publishing stuff on handwashing for quite a few years.

This is one of their papers but they've been writing quite a lot of more recent stuff too.

Edit - for example This paper from 2013

Manufacturers like to make us think that soap is essential for hygiene, but research shows that friction is the main mechanism involved in decontaminating hands.

In situations where hands are not visibly soiled, a purposeful hand wash under running water for 20 s, with friction, will deliver an effective outcome that can be improved marginally by the addition of soap.

A colleague of mine told me once that the London School of Hygiene & Tropical Medicine had come to a similar conclusion - though I can't find the reference.

Source: Miller Thomas, Patrick Daniel, Ormrod Douglas. Hand decontamination: influence of common variables on hand-washing efficiency. Healthcare Infection 2011; 16: 18–23.
dx.doi.org/10.1071/HI10027

I think I recall reading that alcohol gel does not necessarily work as well as soap. British hospitals with problems of infection now insist that visitors and staff both wash hands with soap and use the alcohol gel.

Regarding the use of soap, it seems to speak to the behavioural economics that Elizabeth Tilley speaks of here - the overall health benefits of using soap might well be very large, but the immediate cost of buying soap, albeit quite small, might be enough to prevent a change in behaviour.

It seems to me that the problem here is not with the technology - using an extract of leaves rather than soap - but with the behaviours associated with washing hands after anal cleansing.

You are right, I missed the "potentially waterless" part which could be interesting.

I actually have a sample of a silver impregnated piece of cloth that is marketed by a German company for dry hand washing by the way.

What could be also interesting is to find an anti-bacterial liquid that doesn't require rinsing, i.e. one you can splash on your fingers that will not be sticky when dried and maybe even smell nicely.
I think "bamboo vinegar" could be such a liquid that can also be produced locally. It is quite acidic though and might stress the skin too much.

I agree with Kris' concerns regarding human behaviour and attitudes towards handwashing. However, maybe the more interesting aspect about these two research projects is that they could lead to "hand washing without water", i.e. killing pathogens on hands without the use of water? Is that perhaps the novel aspect of it, that would be different to the use of soap?

Such a powder or gel could therefore be used in settings where water is scarce or unavailable: any place where women have to walk long distances and carry 20 kg of water on their heads to bring the water to their households (= water is precious and maybe people don't want to "waste" it for handwashing), or e.g. at markets and public places in the city, certain work places etc. (I know people in Germany and UK who carry those little hand sanitiser spray things with them and use them after using public toilets for example or before/after shaking hands - I know, a bit exaggerated; but remember during the swine flu epidemic in Europe? People were suddenly more aware again of clean hands - thanks to the media hype...).

The article on Moringa that is linked above doesn't clearly say if hands could be cleaned without water (and only with Moringa), but I think that could be inferred:

Methods:
Hands treated with dried Moringa oleifera received one of the 3 different amounts (2, 3 or 4 g) whilst hands treated with wet Moringa oleifera received 2, 3 or 4 g of the herb powder plus 20 ml of tap water which was added on the top of the Moringa powder deposited previously into each pair of hands. In both cases the participants then rubbed their hands with the product for 1 minute. Hands were rinsed under running water for 15 seconds and were allowed to dry for 3 minutes.

Discussion:
[...] In this study we have demonstrated the effect of dried Moringa oleifera leaves in reducing bacteria on hands. It would be very interesting to test the bacterial reduction effect of fresh leaves. The possibility of using fresh leaves could facilitate its use as preparation process would not be necessary, opening up new avenues for its use, for example in open defecation places where Moringa trees are available.

Conclusion
Four grams of Moringa oleifera powder in dried and wet application had the same effect as non-medicated soap when used for hand washing. Moringa oleifera could be very useful in places where soap or water is not available, and where this tree grows naturally. It could also be a cheap and healthy hand-washing optional product. Our data have been obtained in a laboratory setting, so the next step will be to try this product in real conditions and study its acceptability and convenience for potential users. Moringa oleifera formulations should be investigated further in randomized controlled trials.

Source: www.biomedcentral.com/1472-6882/14/57
(how nice that they published in an open access journal! --> "This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.)"

Regards,
Elisabeth

Dear Krischian,

You're probably right, however I barely ever saw any soap localy made available (I just know central africa and south east asia) in the developping world. In Cambodia, I don't remember the price difference between soap and washing powder but most people were washing hands with very agressive chemical washing powder, when they were.

On another hand even at a very low price, we're always dealing with people who earn so little that every cent saved is meaningful. That would be interesting to know what represent monthly soap expenses for low income families all over the world, I'm pretty sure it's significant in percentage.

Wishing you all a good day,

Ben

Moringa is an interesting plant for many reasons, but making soap is not very difficult and market penetration of cheap commercial products is quite high too.

Therefore I doubt that "soap not being available" is a relevant concern expect for the most remote areas, and "soap is too expensive" is probably also not the main issue (but low willingness to pay might be).