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r IMPROVING PERSONAL AND DOMESTIC HYGIENE PDF

206 Pages·2012·6.01 MB·English
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r ~ ______ --4. - ~ ~O3.1 94Th IMPROVING PERSONAL AND DOMESTIC HYGIENE: Does it reduce diarrhoeal disease? LLBRARY INTERNATIONAL I~EFERENCECE~NTRE FOR COMMUN~WATER ~UPPL1 AND SANITAT~N(I1~C1 Dr. VINCENZO PISANI London School of Hygiene and Tropical Medicine MSc Public Health in Developing Countries University of London, England September 1994 203. 1—941M—12165 --- -— ---~ 2 r—~ _ ~ S To all my classmates. It was a great honour to learn with them. And from them. LIBRARY, INTERNATIONAL REFERENCE CENTRE FOR COMMUNITY WATER SUPPLY AND SANITATION (IRC) P.O. Box 93190, 2509 AD The Ha~u 4’ Tel. (070) 814911 ext 141 /142 RN: ~,, LQ: Z03. It is better to be healthy than ill or dead. That is the beginning and the end of the only real argument for preventive medicine. It is sufficient. (Geoffrey Rose, 1992) INDEX Introduction 1 1.1 Diarrhoea disease: magnitude of the problem 1 1.2 Oral Rehydration Therapy 3 1.3 Primary prevention 7 2 Personal and Domestic Hygiene 11 2.1 Diarrhoea transmission 11 2.2 Barrier to transmission 12 2.3 Handwashing 14 2.4 Sanitary disposal of faeces 17 2.5 Keeping water free from contamination 19 2.6 Corralling domestic animals 21 3 Review on how to measure behaviour change 23 3.1 Introduction 23 3.2 Observation vs. interview 24 3.3 Comparative studies 28 3.4 Conclusion on measuring behaviours 32 3.5 Further work needed 34 4 Health impact of improving hygiene behaviours 37 4.1 Methods 37 4.2 Studies on hygiene behaviour and diarrhoea 38 4.3 Observational studies 43 4.3.1 Case-control studies 45 4.3.2 Cohort studies 47 4.3.3 Summary of observational studies 49 4.4 Intervention studies 51 4.4.1 Handwashing interventions 54 4.4.2 Mixed hygiene education interventions 58 4.4.3 Integrated environmental interventions 63 4.4.4 Summary of intervention studies 67 5 Conclusion and recommendations 69 5.1 Is that effective? 69 5.2 Practical implications 73 -Acknowledgments 77 —References 78 -Appendices 88 S 1. INTRODUCTION 1.1 DIARRHOEA DISEASE: MAGNITUDE OF THE PROBLEM There are 631 million of under five children in the world (The World Bank, 1993); of these, 522 million (83) live in Demographically Developing Countries (DDC). Each of these children experiences an average of 2.6 episodes of diarrhoea per year (Bern et al, 1992), which means a global total of 1.35 billion of diarrhoeal episodes every year in DDC. The incidence is different in the various segments of the childhood, ranging from 1.0/child/year in the 4-5 aged to 4.6 in the 6—11 months aged. (Fonck, 1993). Many would argue these figure are too low. Kirkwood (1991) calculated a median of ~.9 episodes per child, which would bring the annual total to 2.5 billion. In another review (Huttly, 1990) incidence estimates based on more than 350 cross—sectional surveys in 70 countries have yielded a global median incidence rate of 3.4 episodes/child/year. The diarrhoeal mortality rates have been estimated 18.5/1000 live births in infants and 8.9/1000 in child aged 1—4 years (Fonck, 1993), which brings to 3.2 million the total of under five who die of diarrhoea every year in Developing Countries. This is lower than the 1982 estimation of 5 million (Snyder & Merson, 1982), but still account for one quarter (24.8) of all the deaths in Developing Countries. (Tulloch & Richards, 1993) S

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