Assessment of the Impact of a Hygiene on Environmental Sanitation, Childhood Diarrhoea, and the Growth of Children in Rural Bangladesh

Abstract

A community-based hygiene intervention was developed and implemented in five villages of lowland Bangladesh with the active participation of members of the target group, with the objective of reducing childhood diarrhoea by altering ground sanitation and personal and food hygiene practices such as the washing of hands with ash before handling food and after defecation-related activities, cutting fingernails, removing faeces from the child's body and from the yard, using tube-well water for preparing baby food, and reducing supplementary feeding contamination by proper cleaning of bottles or avoiding bottle-feeding. The project area, typical of Bangladesh, was selected because of its pour hygiene and sanitation conditions and its high rates of diarrhoea and malnutrition. Households with children 0–18 months old in five contiguous villages were targeted for the intervention. Households with children in the same age range in a comparison (control) site selected for observational study without intervention were exposed to about the same amount of contact with the researchers. Baseline surveys of the subset of households with children 9–18 months old were conducted at the control site in July 1985 and at the intervention site in September. The intervention activities were carried out from January to July 1986. A final survey was conducted at both sites in August 1986, using the same questionnaire as for the baseline survey and the children who were then in the same age range, 9–18 months. Both sites had higher cleanliness scores, lower diarrhoeal morbidity, and better growth status at the end of the study period, but the improvement was greater at the intervention site. The effect at the control site may be attributed to the intensive observation exposures, mothers’ education, and socio-economic conditions of the households, whereas the intervention site effects were most likely due to the intervention activities. For evaluation of the effect of interventions, the repeat cross-sectional survey may be adequate for measuring relatively stable outcomes such as knowledge and practices, as well as cumulative growth status, but inadequate for fluctuating morbidity.