The promotion of critical times for handwashing has done much to improve knowledge on hygiene, even if rather less on the practice. However while there has long been a recognition of the need to wash hands before preparing food, there has never been any mention of taking the same precautions before drawing water. With almost half of rural Africa still taking water either by bucket and rope or by scooping water from surface and shallow ground water, lack of handwashing can not only lead to contamination of the water being carried home, but also of the source itself, as demonstrated by source water quality monitoring detailed in this paper. Even for those taking water from better protected sources, dirty hands can lead to contamination of collected water, especially where bowls and buckets are the main vessels for water transport. Handwashing before water collection is proposed as an additional barrier to faecal-oral contamination, to make a sixth critical time.

Curtis, V. and Cairncross, S. (2003) ‘Effect of washing with soap on diarrhoea risk in the community: a systematic review’, Lancet Infectious Diseases 3(5): 278–81 <http://dx.doi.org/10.1016/j.ijheh.2005.11.004>.

Ejemot, R.I., Ehiri, J.E., Meremikwu, M.M. and Critchley, J.A. (2009) Handwashing for Preventing Diarrhoea (A Review), The Cochrane Collaboration. Chichester: John Wiley Publishers.

Ferron, S., Morgan, J. and O’Reilly, M. (2000) Hygiene Promotion: A Practical Manual for Relief and Development, Rugby: IT Publications.

Global Public–Private Partnership for Handwashing (2012) Handwashing Behavior Change Think Tank Summary [pdf] 20–21 June 2012, New York <www.washplus.org/sites/default/files/Handwashing_Think_Tank_Summary2012_0.pdf> [accessed 9 February 2015].

Luby, S. (2011a) ‘The impact of hand washing at recommended times’, Global Forum on Sanitation and Hygiene, Mumbai, India, 12 October 2011 [pdf] <http://wsscc-global-forum.org/wp-content/uploads/2011/10/Critical-Handwashing-Times-Mumbai-Pre.pdf> [accessed 10 February 2015].

Luby, S.P., Halder, A.K., Huda, T., Unicomb, L. and Johnston, R.B. (2011b) ‘The effect of hand washing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study’, PLoS Med 8(6): e1001052 <http://dx.doi.org/10.1371/journal.pmed.1001052>.

WHO/UNICEF (2010) Rapid Assessment of Drinking Water Quality, in the Federal Democratic Republic of Ethiopia, Geneva: WHO; New York: UNICEF.

Wright, J., Gundry, S. and Conroy, R. (2004) ‘Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use’, Tropical Medicine International Journal 9(1): 106–17 <http://dx.doi.org/10.1046/j.1365-3156.2003.01160.x/pdf>.

Curtis, V. and Cairncross, S. (2003) ‘Effect of washing with soap on diarrhoea risk in the community: a systematic review’, Lancet Infectious Diseases 3(5): 278–81 <http://dx.doi.org/10.1016/j.ijheh.2005.11.004>.

Ejemot, R.I., Ehiri, J.E., Meremikwu, M.M. and Critchley, J.A. (2009) Handwashing for Preventing Diarrhoea (A Review), The Cochrane Collaboration. Chichester: John Wiley Publishers.

Ferron, S., Morgan, J. and O’Reilly, M. (2000) Hygiene Promotion: A Practical Manual for Relief and Development, Rugby: IT Publications.

Global Public–Private Partnership for Handwashing (2012) Handwashing Behavior Change Think Tank Summary [pdf] 20–21 June 2012, New York <www.washplus.org/sites/default/files/Handwashing_Think_Tank_Summary2012_0.pdf> [accessed 9 February 2015].

Luby, S. (2011a) ‘The impact of hand washing at recommended times’, Global Forum on Sanitation and Hygiene, Mumbai, India, 12 October 2011 [pdf] <http://wsscc-global-forum.org/wp-content/uploads/2011/10/Critical-Handwashing-Times-Mumbai-Pre.pdf> [accessed 10 February 2015].

Luby, S.P., Halder, A.K., Huda, T., Unicomb, L. and Johnston, R.B. (2011b) ‘The effect of hand washing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study’, PLoS Med 8(6): e1001052 <http://dx.doi.org/10.1371/journal.pmed.1001052>.

WHO/UNICEF (2010) Rapid Assessment of Drinking Water Quality, in the Federal Democratic Republic of Ethiopia, Geneva: WHO; New York: UNICEF.

Wright, J., Gundry, S. and Conroy, R. (2004) ‘Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use’, Tropical Medicine International Journal 9(1): 106–17 <http://dx.doi.org/10.1046/j.1365-3156.2003.01160.x/pdf>.

Curtis, V. and Cairncross, S. (2003) ‘Effect of washing with soap on diarrhoea risk in the community: a systematic review’, Lancet Infectious Diseases 3(5): 278–81 <http://dx.doi.org/10.1016/j.ijheh.2005.11.004>.

Ejemot, R.I., Ehiri, J.E., Meremikwu, M.M. and Critchley, J.A. (2009) Handwashing for Preventing Diarrhoea (A Review), The Cochrane Collaboration. Chichester: John Wiley Publishers.

Ferron, S., Morgan, J. and O’Reilly, M. (2000) Hygiene Promotion: A Practical Manual for Relief and Development, Rugby: IT Publications.

Global Public–Private Partnership for Handwashing (2012) Handwashing Behavior Change Think Tank Summary [pdf] 20–21 June 2012, New York <www.washplus.org/sites/default/files/Handwashing_Think_Tank_Summary2012_0.pdf> [accessed 9 February 2015].

Luby, S. (2011a) ‘The impact of hand washing at recommended times’, Global Forum on Sanitation and Hygiene, Mumbai, India, 12 October 2011 [pdf] <http://wsscc-global-forum.org/wp-content/uploads/2011/10/Critical-Handwashing-Times-Mumbai-Pre.pdf> [accessed 10 February 2015].

Luby, S.P., Halder, A.K., Huda, T., Unicomb, L. and Johnston, R.B. (2011b) ‘The effect of hand washing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study’, PLoS Med 8(6): e1001052 <http://dx.doi.org/10.1371/journal.pmed.1001052>.

WHO/UNICEF (2010) Rapid Assessment of Drinking Water Quality, in the Federal Democratic Republic of Ethiopia, Geneva: WHO; New York: UNICEF.

Wright, J., Gundry, S. and Conroy, R. (2004) ‘Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use’, Tropical Medicine International Journal 9(1): 106–17 <http://dx.doi.org/10.1046/j.1365-3156.2003.01160.x/pdf>.

Curtis, V. and Cairncross, S. (2003) ‘Effect of washing with soap on diarrhoea risk in the community: a systematic review’, Lancet Infectious Diseases 3(5): 278–81 <http://dx.doi.org/10.1016/j.ijheh.2005.11.004>.

Ejemot, R.I., Ehiri, J.E., Meremikwu, M.M. and Critchley, J.A. (2009) Handwashing for Preventing Diarrhoea (A Review), The Cochrane Collaboration. Chichester: John Wiley Publishers.

Ferron, S., Morgan, J. and O’Reilly, M. (2000) Hygiene Promotion: A Practical Manual for Relief and Development, Rugby: IT Publications.

Global Public–Private Partnership for Handwashing (2012) Handwashing Behavior Change Think Tank Summary [pdf] 20–21 June 2012, New York <www.washplus.org/sites/default/files/Handwashing_Think_Tank_Summary2012_0.pdf> [accessed 9 February 2015].

Luby, S. (2011a) ‘The impact of hand washing at recommended times’, Global Forum on Sanitation and Hygiene, Mumbai, India, 12 October 2011 [pdf] <http://wsscc-global-forum.org/wp-content/uploads/2011/10/Critical-Handwashing-Times-Mumbai-Pre.pdf> [accessed 10 February 2015].

Luby, S.P., Halder, A.K., Huda, T., Unicomb, L. and Johnston, R.B. (2011b) ‘The effect of hand washing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study’, PLoS Med 8(6): e1001052 <http://dx.doi.org/10.1371/journal.pmed.1001052>.

WHO/UNICEF (2010) Rapid Assessment of Drinking Water Quality, in the Federal Democratic Republic of Ethiopia, Geneva: WHO; New York: UNICEF.

Wright, J., Gundry, S. and Conroy, R. (2004) ‘Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use’, Tropical Medicine International Journal 9(1): 106–17 <http://dx.doi.org/10.1046/j.1365-3156.2003.01160.x/pdf>.