Abstract
{ "background": "In post-conflict urban settings, sustainable improvements in domestic hygiene are critical for public health. Community-led total sanitation (CLTS) campaigns have been widely promoted, but their specific impact on habitual handwashing behaviour and material availability in low-resource households requires further comparative analysis.", "purpose and objectives": "This study compares handwashing behaviour and soap availability in households exposed to a structured community-led hygiene promotion campaign versus those in similar, non-exposed neighbourhoods in Monrovia. It aims to determine the campaign's effect on both practice and enabling conditions.", "methodology": "A cross-sectional comparative design was employed. A stratified random sample of 400 households was drawn from campaign and control neighbourhoods, matched for socio-economic status. Data were collected via structured observations of handwashing facilities and a validated survey on self-reported practices. Quantitative data were analysed using logistic regression.", "findings": "Households in campaign areas were 2.3 times more likely to have a designated handwashing station with soap and water present at the time of observation. However, self-reported handwashing at critical times showed only a modest, non-significant increase. A key theme from open-ended responses was that campaign messaging reinforced existing knowledge but did not consistently overcome cost barriers to soap procurement.", "conclusion": "The community-led campaign significantly improved the enabling environment for handwashing (soap and water availability) but had a limited effect on transforming this into ingrained behavioural practice. This suggests a decoupling of infrastructure from habitual use in this context.", "recommendations": "Future hygiene promotion programmes should integrate targeted, sustained behaviour change communication with material support mechanisms to address economic constraints. Monitoring should move beyond infrastructure checks to include direct behavioural measures.", "key words": "hygiene behaviour, community-led total sanitation, handwashing, urban health, Liberia, WASH", "contribution statement": "This study provides novel empirical evidence on the distinct effects of a community-led campaign on the material and behavioural dimensions of handwashing, highlighting a critical