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Hand washing practices among the communities surveyed was highest before and after eatingand after defecation with little difference between Lowland and Mountain ecological zones.Among the Lowland communities, more than two thirds (75.5%) of the people wash their handsafter eating, while 70.1% washed before eating and 61.3% after toilet use. Among theMountainous areas, 70.6% wash their hand before eating, 70.5% after eating and further 63.8%after using the toilet. Use of soap for hand washing in general was good. Mountainous areasreported slightly higher use of soap to wash hands (97.2%) than Lowland areas (92.7%).Table 19: Percent distribution of households by type of toilet/latrine facilities and hand washingpractices, according to ecological zones, Lahj governorate, July 2012Lowland MountainousEcological Zone% N % NToilet facilityImproved toilet facility 41.7 333 50.6 357Type of toilet facilityToilet - Flush/Pour flush 39.2 313 46.2 326Toilet - uncovered pit 40.8 326 45.0 317Toilet - simple dry covered pit 2.5 20 4.4 31Outdoors in the open air (in fields, for example) 16.4 133 4.4 31Other 0.9 7 0 0When do you wash your handsAfter using the toilet 63.8 510 61.3 432Before eating 70.6 564 70.1 494After eating 70.5 563 75.5 532Before cooking 51.2 409 53.1 374Before feeding the child 15.5 124 15.5 109After disposing of child’s waste 18.1 145 17.2 121After cleaning the livestock or poultry areas 17.8 142 20.4 144Substance used to wash handSoap 92.7 741 97.2 685Ashes, dust, limestone powder, tree leaves 5.5 44 1.4 104.9. Programme coverage4.9.1. ImmunizationThe availability of vaccination cards for registering each vaccination is very important forfollowing up the child’s health status and for accurately measuring the coverage by differentvaccinations. The data showed that the percentage of children who had a health card that wasseen by the interviewer does not indicate significant differences in the two ecological zones,43