Table 2.

Examples of complementary data behind WASH insights

Summary insight	Quantitative survey data	Qualitative BIS data
1. Good knowledge of germs and parasites as a cause of NTDs was strongly associated with better WASH behaviours	(DRC) When asked about causes of NTDs, without prompting, 43% mentioned dirty water; only 22% mentioned germs, parasites, flies and mosquitoes. Behaviours such as using a latrine (15%), sleeping under a net (12%) or controlling insects (12%) were seldom first thought of as disease-prevention measures.	Where germs and parasites were identified as a cause of NTDs (without being prompted) there was significantly more awareness of insect bite avoidance and handwashing practices, compared with those who did not make the connection between NTDs and parasites. For example, people covered their food to prevent flies from contaminating it.
2. However, behaviour often does not match knowledge	(Nigeria) 96% felt it was important to wash their hands. However, 43% felt that washing without soap was fine, and only 67% said handwashing after using the toilet was important.	Families often told us about the importance of soap, and clearly understood its importance in disease prevention, but failed to use it consistently. Soap use after using the latrine was particularly poor. This was largely attributed to the cost of hand soap. Cheaper alternatives, such as detergents and ash, were referred to. Admitted complacency was common.
3. Mothers/women drive household WASH routines. WASH competencies were mostly demonstrated by the female head of the household	(Nigeria) 50% of women said they made decisions regarding water use in the household (compared with a significantly smaller 33% of men). The reverse was true for decisions about health in the household; 51% of men said they made decisions, compared with just 25% of women.	Females make daily decisions about how water is used in the home; they direct children to wash hands and fetch water; they do the cooking and cleaning. Households do not approach disease prevention holistically; while women are largely responsible for the use of water in the household, men make decisions about healthcare. There were few joint decisions made between spouses.
4. Temporal aspects of WASH often revolve around mealtimes and prayer times	(Nigeria) 39% cited religious activity as a trigger for handwashing. (Guinea Bissau) 91% felt that washing hands before eating was important.	WASH routines, dining routines and religious adherence are temporal: same time of day, every day. Spontaneous handwashing or facewashing was seldom enacted, and was done largely for comfort, not disease prevention.
5. Spatial aspects of WASH largely involve the yard outside the home	(Guinea Bissau) People in the city were significantly less likely to wash their hands after using the toilet: 36% compared with 56% of those in the rural area. 75% shared a toilet with other households.	Toilets are often shared and located outside the home, impacting handwashing. Routines, including WASH practices, are largely conducted outside of the home (e.g. a lack of indoor kitchen space meant food was prepared and cooked outside in the yard).