Infectious disease risk communication and engagement using puppetry and related approaches for improving handwashing with soap in an informal settlement of Nairobi

Handwashing with soap (HWWS) has been estimated to have the potential to prevent 35% of the 704,880 deaths per year caused by diarrhoeal infectious diseases (UN Millennium Project, 2018), its wider risk reduction influence subsequently accentuated in times of COVID-19. However, this depends on place specific risk communication that leads to behaviour change, particularly amongst children in economically poor neighbourhoods. A study centred on five schools in the informal settlement of Kawangware, Nairobi found that puppetry, shadow shows and school model making produced effective risk communication and engagement spaces. Increased HWWS occurred when children designed, owned, and were able to apply risk communication.