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Bangladesh has one of the highest maternal death rates in the world. An estimated 5200 women die each year due to pregnancy or childbirth.



The Problem


Poverty is a key factor in Bangladesh’s high maternal and newborn death rates which have been among the worst in the world. Bangladesh has a maternal mortality ratio of 170 maternal deaths per 100,000 live births and a newborn mortality rate of 24 deaths per 1000 live births. In 2012, an estimated 75,900 newborn deaths occurred.


Our Work


Between 2013-2014, in collaboration with colleagues in India, Bangladesh and the UK, Soapbox developed and implemented novel research methods for capturing evidence on cleanliness and the relationship to water, sanitation and hygiene (WASH) conditions and infection prevention and control (IPC) in health facilities in low-income settings. The research methods included the use of photography and simple microbiology methods, and involved ward cleaners in data collection and capture of photographic evidence.

Results of the research indicated a common problem affecting maternity unit cleanliness across countries – the absence of formal, systematic training of cleaners in IPC and the reliance on visual cleanliness as a proxy for ‘safety’.


Our Impact


Dissemination of the WASH & CLEAN results has generated much interest in both the findings and the data collection tools. The tools have been adapted for use in Zanzibar and Malawi and the CD based WASH & CLEAN Toolkit, which provides a guide to data collection and tools, has been distributed to stakeholders in India, Bangladesh and the UK. Requests for access to the online toolkit have been made from both Africa and Asia. Presentation of results at an expert meeting convened by WHO and UNICEF in Geneva in early 2015 has resulted in the toolkit being used as an example of facility needs assessment and improvement tools to international audiences.

The WASH & CLEAN Toolkit – Assessing Hygiene on Maternity Units: A Guide to Data Collection & Tools is available through our Resources page.

A training manual for IPC and environmental hygiene has also been developed and piloted in the Gambia. Click here for more details.


Our Partners


  • Indian Institute of Public Health, Gandhinagar
  • BRAC in Bangladesh



Our Funders


  • Sanitation and Hygiene Applied Research for Equity (SHARE)
  • Water Supply and Sanitation Collaborative Council