Hygiene

Background

            Many studies have shown that simply providing access to safe drinking water does not translate into diarrhea reduction for communities. One possible explanation for this is the multiple pathways of transmission for diarrheal diseases. Even if water at the source is clean, when introduced to contaminated hands or surfaces, the water will be unsafe to drink. Because of the transmission component, arguments are being made for the inclusion of behavioral interventions to increase proper hygiene practices. Hand-washing and maintaining clean home environments are both health behaviors that have been linked to diarrhea rates (Gorter, 1998).  It is important to note that this is an individual-level behavior modification and strategies that promote this style of intervention must focus on the individual within a larger community (Zwane, 2007, pg. 5).

Handwashing

• Since most diarrheal diseases originate from fecal-oral transmission, hands are commonly the pathway for this contamination.
• One study showed that a hand-washing campaign in Pakistan reduced childhood days of diarrhea 39% in just one year’s time within the households that received the intervention (Luby, 2004, n.p.)
• Two other randomized control trials have shown that hand-washing promotion and soap provision reduced diarrhea incidence 40% in children under two in Rangoon and 67% overall in Bangladesh.
• Hand-washing and education shows promise to help reduce diarrhea incidence in developing countries and has been trialed successfully in Pakistan, Bangladesh, and Rangoon.

Handwashing and Home Cleanliness

• A direct observation study in Nicaragua showed that the two behaviors that had the greatest role in preventing diarrhea were hand-washing before preparing meals and maintaining a clean kitchen floor.
• Among the families that had those two behaviors, they were more likely to have radios or higher education status.
• For intervention purposes this may indicate that hand-washing and home cleanliness could be targeted with radio and educational interventions.
• Even among families were washing hands and maintaining clean homes, knowledge of disease transmission was absent and the main reason for cleaning was for aesthetic purposes.

Suggestions

These studies indicate that health behaviors, like hand-washing, could have a serious effect on diarrhea incidence in the developing world. The critical review study found that hand-washing interventions with education and soap provision components could reduce diarrhea significantly, especially in young children. Another study found that hand washing prior to preparing food and keeping a clean floor were both indicative of disease status for the household. The study also showed that education status and the presence of a radio could enhance these effects. Possible intervention strategies should take these findings into consideration and concentrate on educating mothers on the importance of hand washing and household cleanliness to preventing diarrhea in their children. An effective outlet for this strategy would be to utilize the radio or in place educational structures to promote this behavior.

References

Handwashing

Zwane, A.P. & Kremer, M. What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review. World Bank Reserve Obs, 2007 (0), lkm002v1-24.

Handwashing and Home Cleanliness

Gorter, A.C., Sandiford, P., Pauw, J., Morales, P., Pérez, R.M., & Alberts, H. (1998) Hygiene behaviour in rural Nicaragua in relation to diarrhoea. International Journal of Epidemiology, 27(6), 1090-100.