Health & hygiene

This work supports the following UN Sustainable Development Goals

  • Good Health and Wellbeing
  • Clean Water and Sanitation
  • Partnership For The Goals

Healthy handwashing habits for life

Through Lifebuoy, we have helped over 1 billion people around the world improve their handwashing habits, achieving our 2020 target two years ahead of schedule*. But we’re not stopping there. We will continue to help people improve their handwashing habits to prevent childhood deaths.

Girls washing hands as part of global handwashing day.

Clean water & sanitation for all

Every 23 seconds, somewhere in the world, a child dies from either pneumonia or diarrhoea.1 The simple act of handwashing is the single most effective way of stopping child deaths. It can reduce the number of incidences of pneumonia by 23% and diarrhoea by up to 45%.2

However, washing with water alone isn’t enough to clean hands. Handwashing with soap is crucial. Through Goal 6 of the UN Sustainable Development Goals – ensure access to water and sanitation for all – governments around the world have committed to promoting the importance of handwashing with soap, specifically through Indicator 6.2.1: proportion of population using safely managed sanitation services, including a handwashing facility with soap and water. That’s where we come in – and where we’ve been since 1894.

Making soap & saving lives since 1894

Lifebuoy soap box

Back in 1885, William and James Lever created a soap-producing business – Lever Brothers – declaring it their purpose to ‘make cleanliness commonplace’. In 1894, the brothers launched Lifebuoy soap to combat cholera in Victorian England and make health and hygiene accessible to everyone.

Today, Lifebuoy is the world's number one hygiene soap brand.3 It’s sold in nearly 60 countries and available across Asia, Africa, Latin America and the Middle East. It’s the only soap to be accredited by the Royal Society of Public Health, London. We make it available at the price of €0.12 for a bar of soap, because we believe that best-in-class hygiene should be a right for everyone, not just for the few who can afford it.

Our Lifebuoy handwashing programmes drive behaviour change and also directly drive sales. When more people use soap regularly and have access to sanitation, the impact on health is significant and their use of soap increases. If everyone followed ideal handwashing habits, each person would use approximately 20 bars of soap a year. However, consumption levels are far below this, with 1.5 billion people using less than eight bars of soap per year.

Lifebuoy is one of Unilever’s largest Sustainable Living Brands, with a clear purpose of saving lives through handwashing with soap, supporting targets in our Unilever Sustainable Living Plan.


Medical authorities are clear: washing our hands thoroughly and frequently with soap, or using sanitiser where soap and water are not available, is one of the most effective ways to arrest the spread of the coronavirus (COVID-19).

As the world’s biggest soap company, we have a responsibility to help. So we are deploying our expertise in how to teach people to handwash effectively, whichever brand they choose to use.

In March 2020, we announced that we’re providing free soap, sanitiser, bleach and food to the value of €100 million. Around half of this is going to the COVID Action Platform of the World Economic Forum, which is supporting global health organisations and agencies with their response to the emergency.

We are also partly funding a programme that we announced in partnership with the UK Department of International Development (DFID) to urgently tackle the spread of coronavirus. The programme, which is being led by our Lifebuoy and Domestos brands, will reach up to a billion people worldwide, raising awareness and changing behaviour to make sure people are washing their hands with soap regularly and disinfecting surfaces. The programme will also provide over 20 million hygiene products in the developing world, including in areas where there is little or no sanitation.

The initiative is also supporting UK and international NGOs, as well as other partners, in running programmes to tackle the spread of coronavirus through increasing access to hygiene products; a mass public awareness campaign on the importance of handwashing; and a hygiene behaviour change programme. We are also working with leading academics, including from the London School of Hygiene & Tropical Medicine, to ensure the programme is focusing on where it can have the biggest impact.

Achieving our 2020 target two years ahead of schedule

bar of soap
1.07 billion

Since 2010, we have reached 1.07 billion people (486 million people through on-ground programmes and 587 million through TV reach) through our handwashing programmes*

Soap only works if it’s used effectively and if people wash their hands at the critical moments of the day: before eating and after going to the toilet. Since 2010, we have reached over 1 billion people (486 million people through on-ground programmes and 587 million through TV reach)* across Asia, Africa and Latin America.

We have reached 486 million people through on-ground programmes with mothers and children in schools, health clinics and community outreach programmes, with proven results. We’re working to create transformational change at scale around Water, Sanitation and Hygiene (WASH), but we can’t do this alone. This is why we’re working in partnership with a number of organisations to create the change needed to address global health challenges.

Lifebuoy’s partnerships form the backbone of our handwashing behaviour change programmes. Our partnerships with governments and NGOs enable us to have a greater impact and reach those most in need, playing a key role in contributing to the SDGs.

In addition to our on-ground programmes, we have reached 587 million people through TV adverts.* We had long believed that our total combined marketing efforts – including mass scale TV advertising – were contributing to changing handwashing behaviour. So we ran a randomised control trial in India, our biggest market, to test the effectiveness of Lifebuoy TV adverts. The trial found positive results, which were published by the Journal of Health Communication. Through our TV advertising and on-ground programmes, we surpassed both our handwashing target and Health & Well-being target of reaching 1 billion people two years early.

Changing handwashing behaviour through technology


Lifebuoy behaviour change programme

First mobile phone technology programme to change handwashing behaviour

Governments worldwide are increasingly adopting mobile technologies to deliver public services in areas related to agriculture, education, health and livelihoods. Mobile technologies are widely adopted in developing countries, with 78% of mobile phone users globally from developing economies.4 In India, for example, the only cost-effective way to reach 50% of the population who live in rural areas, is through their mobile phones.

Lifebuoy has designed and piloted a programme using mobile technology that has been proved to change handwashing behaviour. This is the first time that this had been done using mobiles. Our Lifebuoy Mobile Doctarni service reaches women in media-dark rural areas in India, providing mothers with free, easily accessible advice about their child’s health.

The service is based on a missed call mechanism, whereby a mother makes a phone call but hangs up before she is connected. Mobile Doctarni then calls her back, sharing health information adapted to her child or children’s ages. Pilot results were very strong, with high engagement and behaviour change recorded. The campaign increased handwashing with soap at critical public health occasions by more than one per day, and the frequency of handwashing improved by 50% among participants exposed to the campaign.

In 2019, we announced a partnership between Lifebuoy and NGO The Power of Nutrition to reach 2.7 million mothers in India – focusing on Gujarat and Maharashtra – through Mobile Doctarni. As part of the partnership, which was launched at the UN General Assembly, we aim to create a model of Mobile Doctarni that could be replicated effectively in other geographies.

Alan Jope, our CEO, said, “Lifebuoy embodies purposeful brands through its rigorous focus on 'brand do' and making impact on the ground. But breakthroughs at scale can only happen when we work together. This partnership combines Unilever’s and Lifebuoy’s marketing and behaviour change expertise, along with The Power of Nutrition’s innovative funding platform, to tackle poor hygiene and malnutrition in an unprecedented way.”

This work contributes to the following UN Sustainable Development Goals

  • Good Health and Wellbeing)
  • Clean Water and Sanitation)
  • Partnership For The Goals)

Lifebuoy’s Infection Alert System (IAS) ‘always-on’ communication system responds to trending topics and any emerging health infections at the same time people are searching for solutions. It helps Lifebuoy to proactively educate people when they are vulnerable to diseases – and active it through mobile technology, which has the highest reach in rural areas.

The system uses data from the Government of India, which is collected from 34,000 rural community health centres across 822 villages and sub-districts. The algorithm used simplifies big data to help understand the intensity, magnitude and trends of communicable diseases on a weekly basis. When an outbreak is predicted, the IAS activates an automatic calling system that makes an average of 8 million calls each week, alerting people in rural areas on prevalent diseases in their areas and educating them on the importance of handwashing with soap.

So, whether it’s local festivals, seasonal infections or pandemics, through IAS, Lifebuoy reminds people – through a variety of media channels – that handwashing with soap is the most effective and easy protection.

Reaching new mothers

Over 45% of deaths of children under the age of five occur within the first 28 days of a child’s life. Every year, 2.5 million babies die before turning one month old – a significant proportion of them from infections. And around 41%5 of these deaths could be prevented simply by helping new mums and midwives change their handwashing behaviour.

Since 2011, we’ve reached more than 20 million mothers across Asia and Africa with hygiene education through community visits and neonatal clinics. Our largest programmes in Indonesia and Vietnam are run in partnership with government, enabling health workers and women’s groups to teach mothers about handwashing with soap.

In Kenya, we have partnered with Amref Health Africa, launching a programme in 2017 in Migori County, one of the areas with the highest level of neonatal mortality in the country. Through community health workers, support groups and health centres, the programme educated new mothers over a period of six months on the importance of handwashing with soap, raising awareness of the risks of transmitting diseases to their newborn via contaminated hands.

New mothers who took part in the programme were more likely to wash their hands with soap than the control group during three occasions: after changing nappies (26% vs 2%), before breastfeeding (42% vs 3%), and after visiting the toilet (39% vs 10%). In addition, 90% of the new mothers reached talked about the programme to their friends, family and neighbours, highlighting a positive ripple effect.

Powerful storytelling through Lifebuoy’s Help A Child Reach 5 campaign

In 2013, Lifebuoy launched the Help a Child Reach 5 campaign. This aims to raise awareness of the importance of handwashing with soap and encourages people to join us and take an active role.

Our four Help a Child Reach 5 films – Gondappa, Tree of Life, Chamki and Sherry – share a personal, powerful and real perspective on the individual tragedy of losing a child to preventable infections like diarrhoea and pneumonia.

The third and fourth films in the series emphasise the importance of handwashing with soap in the month after birth. They bring to life the aspirations that two expectant mothers, Sangrahi in India and Eunice in Kenya, have for their unborn children. Through this campaign, awareness of Lifebuoy’s lifesaving handwashing message has reached hundreds of millions of people around the world.

Empowering young people to drive change

The Lifebuoy Lifesaver Volunteer Programme harnesses the energy and enthusiasm of teenagers and college students, helping them make a difference in their communities by teaching the importance of handwashing with soap. Through colleges and youth networks, we’ve mobilised more than 150,000 Lifesaver Volunteers to run Lifebuoy’s School of 5 programme in schools.

Now running in five countries, the programme is being scaled up through youth organisations such as the World Association of Girl Guides and Girl Scouts (WAGGGS) and through university students in a volunteer programme launched in 2017. It’s called ‘Heroes for Change’ and is run in partnership with Amref Health Africa.

Joining the programme was one of the best experiences I have had to date! Although the programme has now ended, I often go back and meet the kids. Two months later, they still remember what we taught them.

Student volunteer, Welingkar Institute of Management Development & Research, India


World Association of Girl Guides and Girl Scouts Ceremony

Girl Guide superheroes

Through our partnership with World Association of Girl Guides and Girl Scouts (WAGGGS), and their Indian counterpart, Bharat Scouts and Guides (BS&G), 142,000 girl guides and scouts in India became handwashing heroes by promoting this lifesaving habit within their local communities.

Each handwashing hero is trained in the importance of using soap while washing hands before eating and after using the toilet. We provide materials featuring our School of 5 superhero Sparkle as a Girl Guide. They are equipped with the necessary skills to share these learnings with others, encouraging the practice of using soap at critical occasions.

In total, WAGGGS has reached more than 3 million children and their families through an adapted version of Lifebuoy’s School of Five.

Ana Maria Mideros, WAGGGS’ World Board Chair, said: “At the World Association of Girl Guides and Girl Scouts, we know that every girl has the power and potential to learn, lead and make a positive change in her community and the wider world. We are hugely proud that our partnership with Lifebuoy is helping young people in India to take action and promote handwashing with soap – both at home and in their wider communities. Working with Lifebuoy, Girl Guides and Scouts are driving change, improving hygiene and changing lives.

This work contributes to the following UN Sustainable Development Goals

  • Good Health and Wellbeing)
  • Clean Water and Sanitation)
  • Partnership For The Goals)

Heroes for Change

In Kenya, students are being recruited as agents for social change in the ‘Heroes for Change’ volunteer programme. It’s a social-mobilisation model, leveraging the power of young people, and engaging them through digital social platforms such as WhatsApp, Twitter and Facebook. Led by Unilever in partnership with Amref Health Africa, the UNFPA (UN Population Fund) and Sightsavers, the programme has identified university students as an untapped force for good, as they’re known in their communities for being passionate about creating lasting social impact.

In the first phase of the programme, student volunteers from five universities in Kenya were trained. The volunteers then deployed the behaviour change programmes over a six-month period, to improve health and well-being in their home communities. The training covers health programmes from Unilever brands Lifebuoy, Royco and Pepsodent.

Following the success of Heroes for Change in 2017, the programme is being scaled up in Kenya through the Well Told Stories partnership. Our aim is to create a nationwide network of 100,000 young people.

Celebrating Global Handwashing Day

Each year on 15 October, over 200 million people worldwide take part in celebrating Global Handwashing Day (GHD) across more than 100 countries. Our Lifebuoy brand is a founding partner of the Global Handwashing Partnership.6

Lifebuoy’s GHD activities include making an impact through our handwashing programmes. Our celebrity ambassadors play a major role at events and on social media to attract support from government representatives, influencers and the media.

To mark Global Handwashing Day in 2019, we enlisted the help of almost 100 influencers around the world to amplify our message of handwashing with soap. With a combined reach of over 3.6 million people, influencers included cricket star Shakib Al Hasan in Bangladesh, popular actors Titi Kamal and Christian Sugiono in Indonesia, and Help A Child Reach 5 Ambassador Kajol in India.


Kids washing their hands

Double impact: promoting handwashing & immunisation together

Gavi, the Vaccine Alliance, and Lifebuoy launched an innovative partnership in 2017 to protect children under five from illnesses and premature death. By promoting handwashing with soap and immunisation together – two of the most critical and cost-effective child survival interventions – the partnership aims to improve and save many young lives in India.

The partnership leverages our expertise in behaviour change and marketing capability, as well as our financial support. It draws on Gavi’s investments in strengthening the health system in India and the Vaccine Alliance networks to deliver behaviour change interventions, as well as promoting the benefits of vaccination and handwashing with soap.

The programme, Safal Shuruaat (‘Successful Beginning’) aims to tap into parents’ desire to raise successful children, keeping them infection-free for the best start in life. It engages people in rural areas through a series of short films, shown door-to-door on tablets. The campaign also uses gaming content and leverages the power of digital by sending mobile reminders integrated with Lifebuoy’s programme, Mobile Doctarni.

So far, Safal Shuruaat has reached 500,000 people, with plans to reach 3.5 million people by the end of 2020. Independent evaluation has shown that the programme has helped to increase the incidence of handwashing with soap after defecation fivefold.

“Diarrhoea and pneumonia are two of the most devastating preventable illnesses which claim the lives of millions of children worldwide,” said Dr Seth Berkley, Gavi CEO. “Integrated interventions that begin at birth, including clean water and vaccines, can protect against these diseases. The Gavi and Unilever Lifebuoy partnership is a great example of the public and private sectors working together to help prevent millions of unnecessary deaths and save lives of the most vulnerable children.”

This work contributes to the following UN Sustainable Development Goals

  • Good Health and Wellbeing)
  • Clean Water and Sanitation)
  • Partnership For The Goals)

Tackling blindness through hygiene

Hand and face washing can prevent and control the world’s leading cause of preventable blindness: trachoma. Globally, 158 million people are at risk and the disease is endemic in some of the poorest areas of the world, including countries in Africa and Asia.

We have partnered with international NGO Sightsavers, and have adapted our schools handwashing programme to include face washing in order to address this issue. By the end of 2019, our Super School of 5 programme with Sightsavers in Kenya, Zambia and Ethiopia reached more than 700,000 people and we’ve trained 2,288 teachers in 247 schools to champion the programme.

In Ethiopia, Lifebuoy and Sightsavers have engaged with the Education Ministry to lead school programmes to reduce trachoma as part of the government’s Seqota Declaration, end child undernutrition by 2030. We estimate that these programmes will reach around 173,000 students and over 795,000 people.

An evaluation of the Super School of 5 programme in Kenya showed a significant increase and sustained adoption of observed hand and face washing behaviours, compared to control schools. Supported by other activities and county government, there has been an average 30% reduction in the prevalence of trachoma.

Simple everyday actions to improve hygiene save lives

It’s not easy to change the habits of a lifetime. So we came up with our behaviour-change methodology, Five Levers for Change (PDF | 4MB), to make good hygiene habits part of people’s daily routine. We use them in all our behaviour-change programmes: handwashing, toothbrushing and using toilets.

These five principles are the bedrock of our approach to changing people’s behaviour. For handwashing, the Five Levers principles encourage people to use soap on the five occasions that have the biggest impact on their health: washing hands after going to the toilet; before breakfast, lunch and dinner; and while having a bath.

Lever 1: Make it understood

Many people believe their hands are clean if they look visibly clean. Unfortunately, that’s not true. Our ‘glo germ’ demonstration helps people understand that washing hands with water alone is not enough to get rid of germs. Ultraviolet light demonstrates how the germs can be left behind on their hands when they wash with water alone. Hands are washed again with soap and shown as germ-free under the same ultraviolet light.

Lever 2: Make it easy

For a new behaviour to become a habit, it needs to be seen as easy to do and to fit into daily routines. We make it easy for people to remember when they need to wash their hands through songs, stories, diaries, rewards and daily sticker charts for children. These and other little reminders at home and at school help make handwashing part of children’s – and adults’ – daily routines.

Lever 3: Make it desirable

People don’t usually do something unless they want to. So we make handwashing fun for kids with our School of 5 comic books and stickers. Studies show that people who commit to a future action in public are also more likely to stick to it. Our Lifebuoy school programme uses the classroom soap pledge to foster commitment by asking children to stand up together in class and pledge to wash their hands. Pledging is also an important part of our mothers’ programme, as it brings the family together to pledge to protect the health of their baby.

Lever 4: Make it rewarding

We want to make people feel good for improving their hygiene habits, so we reward good behaviour. For example, children get a reward or recognition if they successfully complete their handwashing diary for a full three weeks.

Lever 5: Make it a habit

Habits are created over time through repetition. Practising a habit consistently for at least 21 days helps to make it a permanent habit.7 That’s why we give children and mothers 21-day diaries – with rewards on completion. We also give teachers activities for 21 days so they repeat handwashing until it becomes a routine.


Lifebuoy Animated Advert

School of 5: Superheroes to the rescue

Our flagship schools programme is a crucial part of Lifebuoy’s handwashing behaviour change programme. Children develop so much of their behaviour during their primary school years and are heavily influenced by their peers. In turn, children also take messages back to their parents and wider communities.

We make Lifebuoy’s School of 5 programme fun, as that’s the best way to get children to do something. And what could be more fun than superheroes?

We teamed up with specialist children’s communications agency, Yoe, to create Lifebuoy’s School of 5 comic book, which aims to make handwashing cool for kids. The five superhero characters – Biff, Pow, Bam, Hairyback and Sparkle – come to life in animations, radio shows, music, games, and school visits. They each have an important message to get across – encouraging children to use soap at the five critical moments in the day: after going to the toilet; before breakfast; before lunch; before dinner; while having a bath.

Available in 19 languages, our School of 5 comic book has reached more than 300 million people worldwide. The large scale of the programme and the numbers of people reached have caused a paradigm shift in the programme’s ability to attract external partners, thereby increasing scale as well as connecting with hard-to-reach communities.

Lifebuoy’s School of 5 programme uses our Five Levers for Change (PDF | 4MB) methodology. These five principles focus on awareness, commitment, reinforcement and reward and they encourage making good hygiene habits part of people’s daily routine.

This work contributes to the following UN Sustainable Development Goal

  • Clean Water and Sanitation)

Tracking impact

In the early 20th century, Lever Brothers understood the importance of tracking progress. They supplied people with charts to record whether they had washed their hands with soap before eating and after using the toilet each day. Today, monitoring, evaluating results and learning from our programmes are a key focus area.

However, measuring handwashing with soap is difficult. Most people know they should wash hands regularly, so there is a significant risk that people overclaim how much they’re washing their hands if we ask them directly. Having run a series of evaluations of our programmes and partnerships over several years, we know the ‘gold standard’ for measuring handwashing is using motion-sensor soap loggers. However, this method is expensive and direct observation covers limited hours of the day, which may cause people to act differently when they’re being watched.

Weighing soap provides an objective measure of the amount of soap used by households. We have also tested and validated an alternative method of measuring handwashing with soap: sticker diaries. These ask respondents to track a whole range of daily activities in pictorial form, with respondents not knowing which daily behaviour we are specifically interested in. A recent academic study8 confirmed that this methodology was less biased than other conventional methods of self-reporting behaviour.

What has tracking shown?

Using sticker diaries, we have seen a sustained increase in the frequency of handwashing with soap. In Indonesia, for example, before Lifebuoy’s intervention, 53% used soap at the critical handwashing occasions. After our intervention, this rose to 75%. Six months later, the figure rose again to 78%, showing a lasting impact.9 A clinical study in India showed that there were 25% fewer incidences of diarrhoea, 15% less acute respiratory infections and 46% fewer eye infections.10 Additionally, our on-ground and mobile neonatal programmes deployed in Kenya and India have shown significant improvement in handwashing with soap on critical occasions.

In 2017, we teamed up with Oxfam to create a customised handwashing programme to reach mothers in an emergency setting after the Nepal earthquake. Results from a structured observation study showed significant increases in handwashing with soap before eating and preparing food (18% and 17% respectively). The programme also proved to significantly impact habits after using the toilet, with 45% more mothers observed washing their hands with soap.11

As part of the DFID-funded, four-year South Asia WASH (Water, Sanitation and Hygiene) Results Programme, the Lifebuoy School of 5 programme reached more than 17 million people. Six months after the programme ended, reports showed a 33% increase in knowledge of the five critical handwashing occasions and a 43% increase in handwashing with soap before dinner.12

As part of the Millennium Villages Project Partnership with Unilever and the Earth Institute in sub-Saharan Africa, handwashing behaviour change and the effectiveness of Lifebuoy’s School of 5 programme were measured in Kenya and Ghana. Electronic loggers showed that there was a 22% increase in handwashing with soap among children who experienced the School of 5 programme compared to children in the control group. Sticker diaries corroborated these results. Children who experienced the intervention also spent 40% more time handwashing each day.13

Looking ahead

We’re working to create transformational change around Water, Sanitation and Hygiene (WASH), but we can’t do this alone. That’s why we’re working in partnership with a number of organisations to create the change needed to address global health challenges.

Our handwashing programmes have grown in scale, innovation and thought leadership since 1894. And, our partnerships with governments and NGOs are enabling us to reach more of those most in need, contributing further to SDG 6.

* The evidence that TV drives handwashing behaviour change comes from a proof of principles study in India. TV reach is reported for nine key markets using 2017 as a representative year.


2 Cairncross, Sandy; Hunt, Caroline; Boisson, Sophie; Bostoen, Kristof; Curtis, Val; Fung, Isacc CH; and Schmidt, Wolf-Peter. Water, sanitation and hygiene for the prevention of diarrhoea –, International Journal of Epidemiology, 2010 39: i193-i205.

3 Calculation based on Nielsen unit sales information for the total markets (approximately 40 countries), for the latest 12-month period available. See for further information.

4Global mobile statistics 2014

5 Rhee, V; Mullany, LC; Khatry, SK; Katz, J; LeClerq, SC; Darmstadt, GL; Tielsch, JM. Maternal and birth attendant hand washing and neonatal mortality in southern Nepal. Archives of Pediatrics & Adolescent Medicine 2008;162(7):603-608.

6 Previously known as the Public-Private Partnership for Handwashing with Soap.

7 Based on a clinical trial involving 2,000 families in Mumbai, India during 2007 and 2008. Published in: Nicholson, Julie A., et al. An investigation into the effects of handwashing intervention on health outcomes and school absence using a randomised control trial in Indian urban communities -, Journal of Tropical Medicine and International Health, 2014 19 no.3: 284-292.

8 Schmidt, W.P., et al. Comparison of structured observation and pictorial 24h recall of household activities to measure the prevalence of handwashing with soap in the community,, International Journal of Environmental Health Research, 2018, 71-81.

9 Based on results from a quantitative behaviour measurement study in Indonesia.

10 Based on a clinical trial involving 2,000 families in Mumbai, India during 2007 and 2008. Published in: Nicholson, Julie A., et al. An investigation into the effects of handwashing intervention on health outcomes and school absence using a randomised control trial in Indian urban communities -, Journal of Tropical Medicine and International Health, 2014 19 no.3: 284-292.

11 Lifebuoy and Unilever’s Chief Sustainability Office partnership with Oxfam, collaborating on a handwashing with soap behaviour change programme for communities affected by flood, earthquake or other type of emergency. The programme was piloted in Nepal following the earthquake in 2015.

12 Department for International Development South Asia WASH Results Programme (SWARP) 2014-2016.

13 Based on children in Ghana participating in our School of 5 intervention, in contrast to a control group who did not take part. The findings of this study were published in 2013 in the Journal of Tropical Medicine & International Health.