Proper hand hygiene is an effective and efficient method to prevent diarrheal disease and acute respiratory infections, and their resulting deaths, particularly for children under 5 years old. Despite this evidence, handwashing rates remain seriously low in the developing world. This study presents results of a mixed methods approach and comprehensive monitoring strategy of five use variables (use of soap, handwashing station functionality, presence of cleansing agent including soap or white ash, ground wetness, and amount of water in the jug) over 2 years for 42–64 appropriate technology handwashing stations located in two communities in Mali, West Africa. Six factors were studied as potentially critical for lasting use of handwashing stations (gender, educational training, water proximity, seasonality, wealth, and station adoption). Statistically significant (p < 0.05) results include: (1) a 29% decrease in use of soap between dry (October–June) and rainy seasons (July–September); (2) 35% decrease in stations with cleansing agent (e.g., soap or white ash) present over 1 year; (3) greater station use in wealthy households; (4) a 27% reduction in cleansing agent present for stations further from a water source during the rainy season; and (5) greater use of stations built by women in one community.

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