The tradition of washing hands in a common bowl before eating: a qualitative study of the practice of communal bowl hand rinsing before mealtimes, in rural and urban Mali

Abstract Background Communal bowl hand rinsing (CB-HR) refers to the premeal practice where two or more people wash hands, in a shared bowl of water without the use of soap, and without changing the water between individuals. This remains a commonplace cultural practice in many African countries. It occurs before household mealtimes, at gatherings and in schools. This practice is relevant from a public health perspective because individual handwashing with soap is widely recognised as a key measure in preventing the transmission of enteric pathogens. Diarrhoeal disease remains a leading cause of death among children under five globally, despite being largely preventable. Evidence demonstrates that the communal water provides a reservoir for communicable diseases, however there is limited evidence about the motivations including the social and cultural norms linked to its continued practice. The aim of this study is to explore social and cultural perspectives underpinning the continued practice of CB-HR in rural and urban Mali. Methods We conducted 59 semi-structured interviews and 26 focus groups, in the local language of Bambara, across both rural and urban communities in Mali. Participants included mothers, fathers, grandmothers and elders. Recordings were transcribed into French, translated into English and analysed using thematic analysis. Results CB-HR was commonplace amongst our participants; they confirmed that CB-HR was rooted in tradition for the purposes of social cohesion and family unity. The exact way in which CB-HR was practised varied. There was wide awareness of the infection-related risks associated with CB-HR. Maintaining tradition, unity and cohesion, and water scarcity were some of the reasons given for not practising and maintaining individual handwashing with soap. Ways of combining CB-HR and individual handwashing with soap were described, including the need for role models to maintain motivation. Conclusion CB-HR was widespread in our rural & urban sample despite knowledge of its health risks, and access to running water and handwashing equipment (vessels and soap) because participants practicing CB-HR saw it as central to the maintenance of social cohesion. Programmes aimed at improving infection control need to address the social and cultural drivers of CB-HR, or to adapt interventions in ways that are not perceived to threaten family unity.