r IMPROVING PERSONAL AND DOMESTIC HYGIENE

206 Pages·2012·6.01 MB·English

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. [phone] 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