Hand Washing for Children, by Children

Please Note: This blog has been copied with permission from CFK Africa‘s site, “Stories of Progress.” CFK Africa is an international nongovernmental organization, a registered 501(c)(3) nonprofit in the US, and an affilated entity of UNC Chapel Hill. The organization was co-founded by Tabitha Festo (a Kenyan nurse living in Kibera), Salim Mohamed (a Kenyan community organizer), and Rye Barcott (a UNC student) as “Carolina for Kibera” in 2001.

The post was written by Sarah Lebu, a CFK Africa 2022 Peacock Fellow and Ph.D. student in Environmental Science and Engineering at Gillings.

This story begins with the dong of a school bell. Immediately after, young learners, aged between six to thirteen years fill the school compound. Playgroups begin to form, lunch boxes are popped open, and happy shrieks are heard. Not too far away, a few children are washing their hands at a handwashing station by the school administration building.

Children washing their hands
Students washing their hands in school

Handwashing is one of the most effective ways to help prevent diarrheal-related diseases among children. In Kenya, the prevalence of diarrhea among children under 5 is 15%. The rate is even higher (18.7%) among children who live and go to school in informal settlements

Behavior Change Communication is an approach to hygiene promotion that uses an in-depth understanding of people’s behavior to design persuasive communication. At CFK Africa, children are engaged as equal and active participants in designing messaging around handwashing in schools. The design process starts by trying to understand on a deeper level how children think and feel and what motivates them to practice or not practice a behavior.

A Collaborative Design Process

Sarah holding a poster while talking to a group of children
Leading a focus group discussion with students on hand washing murals

Through focus group discussions with five to six children each, we created a research experience that is respectful, safe, and allowed children to share their views without fear. The groups had a varied composition: mixed-gender, mixed-age, and mixed-grade. We asked children to share their perspectives, needs, and motivations around handwashing. The process also captured nuances in design preferences around color, fonts, and choice of images used. As a CFK Peacock Fellow, I had the opportunity to facilitate two focus group discussions.

We learned that having mural designs with simple messaging, bright colors, and playful images of children were appealing to children and created a positive learning environment. The color white and sparkling hands were associated with cleanliness, while some children thought the color brown was akin to dirt and germs. The responses from children were compiled and shared with the design team to produce a child-friendly mural design.

Children as Agents of Change

To date, CFK Africa has facilitated the painting of collaboratively designed, child-friendly murals in 10 schools across two counties. The reception of the message on the murals has been positive so far. In the schools with the mural paintings, children are washing their hands more often, as often as required. We are also seeing evidence of children becoming agents of change. Young learners in schools are sharing positive hygiene messages with their near-peers (e.g., siblings and friends in the same age group). These messages are further cascading to households and communities. Such is the power of child-centered design.

Hand washing mural commissioned by CFK Africa in a school

However, the challenge is far from over. CFK Africa plans to work with public health officers and education officers from county governments to encourage more conversations around proper handwashing among children. For example, a training was held for members of school health clubs, dubbed WASH champions, to equip them with tools and knowledge to create more awareness among their peers on handwashing. Educators and partners working to improve hygiene among children can learn some valuable lessons from this process.

Exploring Malaria, Anemia, and Helminth Infection in Benin


I have recently completed my practicum and conducted research with a team from UNC and the École des Hautes Etudes en Santé Publique in France. Together, we have worked on a qualitative sub-study based in a semi-rural area of Benin.

Over this summer, I developed a codebook to analyze thirty transcripts on maternal depression and knowledge and behaviors associated with anemia, malaria, and helminth infection among women and children. Additionally, I have learned to use a new qualitative analysis software, Dedoose, to facilitate the analysis process. Through my practicum, I have further developed my qualitative analysis skills and acquired new tools to expand my research scope. Focusing on the experiences of women during their maternal health period has also allowed me to gain a more nuanced understanding of maternal health challenges associated with infectious diseases and mental health. I hope to further these insights in future projects on maternal health, specifically in sub-Saharan Africa. Through my data analysis, I have also gained insight into social and structural factors that impact adherence to treatment plans and health promotion, such as challenges with the affordability of treatment and lack of knowledge surrounding treatment options.

This practicum experience has been incredibly rewarding and informative and has set me on a path toward further exploring maternal and child health!

– Amina

Green Means Go: Wrapping up My Experience with an Obstetric Triage Intervention in Ghana

Though this summer is coming to an end and my amazing practicum experience with it, rather than coming to a full stop, I feel like my work in public health is moving full steam ahead. Transportation references aside, my practicum this summer focused on the qualitative analysis portion of an implementation science evaluation of the national scale up of a midwife-led Obstetric Triage Intervention Package (OTIP) in high-volume hospitals in Ghana [1].

View of buildings and skyline in Accra
Accra, Ghana; Photo Credit to Caitlin Williams

The final stretch included analyzing and interpreting all the transcribed interviews and synthesizing the data into a report and presentation targeted toward a general policymaking audience. I had expected the most challenging aspect of the practicum to include the process of developing a codebook for the interviews and the subsequent coding process, but I was surprised by the work that came after—what did all of this data mean? How would this translate into something practical and applicable? There was a lot of floundering and panic on my part, but the process of creating this “results” report was an ultimately rewarding one—I learned so much more about qualitative research, maternal and child health, and implementation science, and more importantly, how much I still have to learn. I look forward to making the connections between what I learned during this practicum experience and the classes I will be taking in the Fall (I’m looking at you HBEH 784 – Implementation Science in Global Health).

Bibimbap food on a towel with the beach in the background
Bibimbap at the Beach; Photo Credit to Anamika Devi

Once again, this hybrid/remote practicum model has allowed me the opportunity to explore more of my new home. My last summer trip included a visit to the Outer Banks Beach area. As a Florida native, I thought I knew beaches but this trip was definitely a learning experience. All of my invertebrate biodiversity class experiences seemed to pay off – I had a great time examining all of the Mollusca specimens in between some nice beach naps.

Finally, thank you to my preceptors, Stephanie Bogdewic, MPH and Caitlin Williams, MSPH for all your patience and mentorship this summer! And thank you to our partners at the Kybele-Ghana organization and the Ghana Health Service for your collaboration and inspiring work in improving the health and well-being of mothers* and children in this project.

– Amy T.

* The author acknowledges and respects the lived experiences of birthing individuals with gender identities not exclusive to cisgender female identities. However, for the purposes of data collection/analysis and recognizing Ghanian cultural values and norms, individuals that give birth have been referred to with traditional binary terminology, including women, females, and mothers.

[1] Williams CR, Bogdewic S, Owen MD, Srofenyoh EK, Ramaswamy R. A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana. Implement Sci. 2020;15(1):31. Published 2020 May 12. doi:10.1186/s13012-020-00992-2