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PubMed1996

Reactivity and repeatability of hygiene behaviour: structured observations from Burkina Faso.

If interventions promoting improved hygiene behaviour to prevent childhood diarrhoea are to be implemented and evaluated, valid methods for measuring this behaviour will be required. This paper presents findings from a study to investigate the use of structured observations to measure hygiene behaviour in Burkina Faso. Two hundred mothers with young children (2-36 months) were observed on several occasions, with particular attention focused on events/behaviour surrounding defaecation. Child defaecation occurred most often in a potty (67% of occasions). Stools were most often disposed of into a latrine (79%). Following defaecation the child's bottom was usually rinsed using water alone with a bare hand (76%). Subsequent hand washing by the mother/caretaker was much rarer (29%). None of these behaviours appeared "reactive" to the presence of the observer. Less common behaviors showed some evidence of reactivity. The frequency of child defaecation in the yard increased over the course of three observations (5% to 16%; P = 0.01) and the proportion of occasions on which the child was observed to be cleaned after defaecation declined (95% to 85%; P = 0.01). Mothers usually took with them to the latrine a water recipient (91%). Hand washing after leaving the latrine was observed on 30% of occasions. This proportion declined from 36% to 22% over three observations (P = 0.05). Defaecation by older siblings (aged 3-5 years) was usually into a potty (48%) or directly in a latrine (30%). There was no evidence that this behaviour was reactive. The repeatability of behaviours at the individual level was generally low. The site of index child defaecation (kappa = 0.27), how the child's bottom was cleaned (kappa = -0.01) and whether the caretaker washed her hands afterwards (kappa = 0.26) all showed low repeatability. The method of stool disposal was more repeatable (kappa = 0.73). Hand washing by mothers after using the latrine showed moderate repeatability (kappa = 0.40). Older sibling's defaecation behavior had excellent repeatability (kappa = 0.90). Our findings suggest that, in studies which aim to measure behaviour at the population level, structured observations may provide a useful tool. Studies which investigate links between hygiene behaviour and diarrhoea incidence at the individual level will require repeated observations of mothers and children since measuring behaviour during a single observation will lead to misclassification of exposure status, resulting in bias which could mask any underlying association. This is likely to be very costly.

Adult↗

PubMedDate not supplied

Assessment of water use and sanitation behavior of a rural area in Bangladesh.

A health development project was established in a rural area of Bangladesh that entailed training village health promoters to provide health education and to motivate families to install tubewells and sanitary latrines. Following a 2-y period of project implementation, the authors sought to assess knowledge and practice of mothers and family members about use of safe water and household tubewells. A household survey in the project area was compared with a similar one in a nearby control area. Three-hundred households in each area were selected, and mothers were interviewed with a standard questionnaire. Significantly more mothers in the health development project area (45.7%) used tubewell water for domestic purposes than in the control area (32.8%). However, hygienic practices of mothers were inadequate. Sanitary latrines were present in less than 20% of households in both areas. Approximately 97% of mothers and 78% of adult family members always used household latrines. However, the use of household latrines by children was low (26.7%). There was no statistically significant difference in the use of household latrines between the project and control areas. The results showed an improvement in use of household tubewells in the project area; however, there was no improvement in sanitation practices of families in the project area. Health education alone, without improvement of socioeconomic status, is not effective in changing behavior.

Adult↗

PubMed2003

Sanitation in the developing world: current status and future solutions.

More than a third of the world's population (2.4 billion people) lacks access to adequate excreta disposal. Four in five of these unserved people are in Asia, with approximately one in five in both India and China, respectively. Even in large Asian cities, less than half of those served are using sewerage systems; the others use on-site systems, from pit latrines to septic tanks. Most have been installed by householders or builders employed by them, rather than by government or municipal agencies. Governments, international agencies and municipalities can never hope to meet the immense gap in provision unless they promote sanitation with a marketing approach. A latrine is a consumer durable which must be sold. It is often considered that the constraint to increasing sanitation coverage is a lack of demand, but there is often a lack of supply of appropriate products, and latrine designs are often too expensive for the poor, requiring subsidies which are captured by the better-off. More market research is needed to define the right product and how best to stimulate demand. Where subsidies are used, the promotion, not the production of the latrines must be subsidised to prevent middle-class capture of the subsidy. Promotion is probably best performed by different agencies from those that build latrines. The expertise and marketing capacity of the private sector needs to be brought into play, and public bodies must learn to assist it effectively in bringing sanitation to all.

Communicable Disease Control↗

PubMed2004

Impact of waste disposal on health of a poor urban community in Zimbambwe.

OBJECTIVE: To assess excreta and waste disposal facilities available and their impact on sanitation related diseases in Epworth, an informal settlement on the outskirts of Harare. DESIGN: Descriptive cross-sectional survey. SETTING: This was a community based study of Epworth informal settlement. SUBJECTS: A total of 308 households were interviewed. Participating households were randomly selected from the three communities of Epworth. Secondary medical archival data on diarrhoeal disease prevalence was collected from local clinics and district health offices in the study areas. RESULTS: Only 7% of households were connected to the sewer system. The study revealed that in Zinyengere extension 13% had no toilet facilities, 48% had simple pits and 37% had Blair VIP latrines. In Overspill 2% had no toilet facilities, 28% had simple latrines and 36% had Blair VIP latrines while in New Gada 20% had no toilet facilities, 24% had simple pits and 23% had Blair VIP latrines. Although a significant percentage had latrines (83.2%), over 50% of the population were not satisfied with the toilet facilities they were using. All the respondents expressed dissatisfaction with their domestic waste disposal practices with 46.6% admitting to have indiscriminately dumped waste. According to the community, diarrhoeal diseases were the most prevalent diseases (50%) related to poor sanitation. Health statistics also indicated that diarrhoea was a major problem in this community. CONCLUSION: It is recommended that households and the local authorities concentrate on improving the provision of toilets, water and waste disposal facilities as a way of improving the health state of the community.

Attitude to Health↗

PubMed1990

A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho.

A health impact evaluation of the Rural Sanitation Pilot Project in Mohale's Hoek district, Lesotho, was conducted from October 1987 to September 1988. A clinic-based case-control design was used to investigate the impact of improved sanitation on diarrhoea morbidity in young children. The results indicate that under-5-year-olds from households with a latrine may experience 24% fewer episodes of diarrhoea than such children from households without a latrine (odds ratio = 0.76; 95% confidence interval, 0.58-1.01). The impact of latrines on diarrhoea was greater in those households that used more water, practised better personal hygiene, and where the mothers had a higher level of education or worked outside the home. In common with studies conducted in Malawi, Philippines, and Sri Lanka, little evidence was found that the relationship between latrine ownership and diarrhoea was confounded by socioeconomic status or environmental variables. For a sample of cases and controls, data on exposure status (presence or absence of a latrine) that were collected by interview at the clinics agreed closely with those obtained by observation during a home visit.

Case-Control Studies↗

PubMed1985

Factors relating to the presence and use of sanitary facilities in rural Swaziland.

Findings related to latrine construction and use in a sample of rural homesteads in Swaziland are summarized from a larger, unpublished sample survey. Anthropological research techniques were also used to gain information on attitudes and beliefs. Pit latrines were found in 21% of the sampled homesteads. The most significant variables in predicting the presence of a latrine were respondent's education and the highest level of education achieved by anyone in the residential unit. Older people and small children were least likely to use a latrine; people with less education were least likely to even have a latrine.

Aged↗

PubMed1994

Women's involvement in a rural Bangladesh water and sanitation project.

Rural women were involved in a water and sanitation project (WSS) in which health impacts were compared between children in two areas: intervention and comparison areas. In intervention area people were provided with handpumps, latrines and hygiene education, whereas, in the comparison area, people did not receive these project inputs. In the intervention area women were directly involved in the site selection of handpumps and latrines, their installation, construction, and maintenance. Observations on women's involvement and their performances in the intervention area are presented. About 89% of the pumps maintained by women (n = 30), and 86% of those maintained by project workers (n = 49) were found to be in good working condition. Women supervised the construction of all 754 latrines, fenced 58% of the projects-supported latrines (n = 268) and emptied the pits of 65% of the 276 filled-up latrines. Socio-cultural factors were not barriers to women's involvement and performance. The findings have policy implications for effective involvement of rural women towards the development of sustainable WSS programs.

Adult↗

PubMed2005

Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe.

Unless strategies are found to galvanise rural communities and create a demand for sanitation, we cannot achieve the United Nations Millennium Development Goal of halving the 2.4 billion people without sanitation by the year 2015. This study describes an innovative methodology used in Zimbabwe--Community Health Clubs--which significantly changed hygiene behaviour and built rural demand for sanitation. In 1 year in Makoni District, 1244 health promotion sessions were held by 14 trainers, costing an average of US dollars 0.21 per beneficiary and involving 11,450 club members (68,700 beneficiaries). In Tsholotsho District, 2105 members participated in 182 sessions held by three trainers which cost US dollars 0.55 for each of the 12,630 beneficiaries. Within 2 years, 2400 latrines had been built in Makoni, and in Tsholotsho latrine coverage rose to 43% contrasted to 2% in the control area, with 1200 latrines being built in 18 months. Although Zimbabwe has historically relied on subsidies to stimulate sanitation, this intervention shows how total sanitation could be achievable. The remaining 57% of club members without latrines in Tsholotsho all practised faecal burial, a method previously unknown to them. Club members' hygiene was significantly different (p<0.0001) from a control group across 17 key hygiene practices including hand washing, showing that if a strong community structure is developed and the norms of a community are altered, sanitation and hygiene behaviour are likely to improve. This methodology could be scaled up to contribute to ambitious global targets.

Community Health Planning↗

PubMed2006

Epidemiological survey of swine cysticercosis using ante-mortem and post-mortem examination tests in the southern highlands of Tanzania.

Pig keeping is known to be popular in the regions of the southern highlands zone (Mbeya, Iringa and Ruvuma) of Tanzania where more than 60% of pigs under the small-scale production system are raised. However, no epidemiological surveys on porcine cysticercosis have been conducted in the zone in spite of unofficial reports indicating the disease to be a widespread problem. To estimate prevalence rates and risk factors for porcine cysticercosis in Chunya and Iringa Rural Districts and Ruvuma Region (Songea and Mbinga Districts), 722, 808 and 302 live pigs, respectively, were examined by lingually and the prevalence of swine cysticercosis was found to be 7.6%, 8.4% and 16.9% for Chunya and Iringa Rural Districts, and Ruvuma Region, respectively. Structured observations and questionnaire interviews were used to analyse pig rearing practices and household use of latrines in Chunya and Iringa Rural Districts only. The analysis of effect of pig management practices, lack of a latrine, eating undercooked pork, home slaughter and no inspection of pork and lack of knowledge of T. solium on their association to tongue positivity in pigs was done by means of a contingency table. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) and p-values were calculated. Structured questionnaire interviews identified factors associated with the disease prevalence in both Chunya and Iringa Rural Districts were free-ranging of pigs, home slaughtering of pigs and pork not being inspected. While in Chunya and Iringa Rural Districts lack of latrine and barbecuing were found a risk factor, respectively. To control the disease in the study areas of the southern highlands there is a need for significant improvements regarding the use of latrines, confinement of pigs, pork inspection and thorough cooking of pork.

Animal Husbandry↗

PubMed2001

A study of risk factors for intestinal helminth infections using epidemiological and anthropological approaches.

This study. conducted in Kisumu District, Kenya, identified important risk factors for infection with intestinal helminths using traditional epidemiological methods. This was combined with a rapid assessment study using qualitative methods, which focused on sanitation practices and local illness perceptions. The multiple logistic regression analysis revealed that the absence of latrines was a significant predictor for hookworm infection with an odds ratio (OR) of 1.9. The analysis also revealed that households without soap had a 2.6 times higher risk of being infected with Ascaris lumbricoides compared with households where soap was available, and that the number of inhabitants living in a household was a significant predictor for infections with hookworms (OR=3.2). Furthermore, the presence of children of 5 years and under in the household was a predictor for infection with A. lumbricoides (OR=2.7), while the absence of this age group was a predictor for hookworm infection (OR=3.8). The qualitative part of the study revealed that people did not consider worms as a serious health threat, but as a nuisance. Among the population. latrines were seen as beneficial because they were believed to prevent disease, to provide privacy and to keep the environment free of faeces. Handwashing was done many times a day but usually not with soap, which was mainly used when bathing or washing the whole body. Many inhabitants in a household or the presence of children of 5 years and under were never mentioned as being a disadvantage, and these elements would therefore be difficult to include in a control strategy. Since the lack of latrines and of soap were identified as risk factors for infection, while latrines, soap and medicine were seen as assets by the population, it is suggested that helminth control interventions should be concentrated within these areas in this particular society.

Age Distribution↗

PubMed2003

Myanmar experiences in sanitation and hygiene promotion: lessons learned and future directions.

Recent activities in connection with the National Sanitation Week (NSW) and Social Mobilisation for Sanitation and Hygiene have contributed to a significant increase in access to sanitary means of excreta disposal, from 45% in 1997 to 67% in 2001. Handwashing with soap and water after defecation has also increased from 18% in 1996 to 43% in 2001. Success is attributable to high level political commitment, state or division level action and community mobilisation by village level authorities. Multi-level efforts such as mass media, planning workshops, training sessions and house-to-house visits by village authorities and health officials have raised greater awareness of sanitation and hygiene issues and led to construction of latrines on a self-help basis. The challenge ahead is to give greater attention to the 'hard to reach' who live in less accessible areas and are more resistant to change. The 2002 NSW has accordingly given special emphasis to activities in 73 of 324 townships where 50% or more of the households have no access to a sanitary latrine. The communication and social mobilisation package has been improved to upgrading unsanitary latrines and integrating handwashing more systematically with promotion of sanitary latrines. Programmatic follow-up to the NSW is being provided in selected townships through more intensive social mobilisation for 'hard to reach' households and activity-based school sanitation and hygiene education. This approach will contribute further towards improved hygienic practices and reduce diarrhoeal morbidity and mortality.

Communicable Disease Control↗

PubMed2004

Risk of disease from wildlife reservoirs: badgers, cattle, and bovine tuberculosis.

Livestock face complex foraging options associated with optimizing nutrient intake while being able to avoid areas posing risk of parasites or disease. Areas of tall nutrient-rich swards around fecal deposits may be attractive for grazing, but might incur fitness costs from parasites. We use the example of dairy cattle and the risks of tuberculosis transmission posed to them by pastures contaminated with badger excreta to examine this trade-off. A risk may be posed either by aerosolized inhalation through investigation or by ingestion via grazing contaminated swards. We quantified the levels of investigation and grazing of 150 dairy cows at badger latrines (accumulations of feces and urine) and crossing points (urination-only sites). Grazing behavior was compared between strip-grazed and rotation-grazed fields. Strip grazing had fields subdivided for grazing periods of <24 h, whereas rotational grazing involved access to whole fields for 1 to 7 d each. A higher proportion of the herd investigated badger latrines than crossing points or controls. Cattle initially avoided swards around badger latrines but not around crossing points. Avoidance periods were shorter in strip-compared with rotation-grazing systems. In rotation-grazing management, latrines were avoided for longer times, but there were more investigative contacts than with strip-grazing management. If investigation is a major route of tuberculosis transmission, the risk to cattle is greatest in extensive rotation-grazing systems. However, if ingestion of fresh urine is the primary method of transmission, strip-grazing management may pose a greater threat. Farming systems affect the level and type of contact between livestock and wildlife excreta and thus the risks of disease.

Agriculture↗

PubMed1991

A study of the association between improved sanitation facilities and children's height in Lesotho.

The impact of improved sanitation on the anthropometric status of children under 5 years in Lesotho was investigated using children recruited into a case-control study of diarrhoea morbidity. The children's height-for-age Z-scores were used as an indicator of chronic undernutrition. Classifying children as 'stunted' or 'adequately nourished' revealed some evidence of an association between latrine ownership and attained height. After allowing for confounding variables, the odds of stunting were 18 per cent lower among children in households with latrines (95 per cent confidence interval, 36 per cent lower to 3 per cent higher). More powerful analyses, using height-for-age as a continuous outcome variable, revealed that the mean height-for-age Z-score of children from households with a latrine was 0.27 standard deviations higher than that of children from households without a latrine (95 per cent c.i. = 0.12 to 0.42). These results suggest that the anthropometric status of children may be as responsive to improvements in sanitation facilities as diarrhoea morbidity in some settings.

Analysis of Variance↗

PubMed1991

Measuring environmental health status in Oukasie, 1987.

This article reports on some aspects of the physical environment and on environmental health services at Oukasie. The data were collected over a weekend in August 1987 by an interview and by direct inspection of the environment using a standard schedule. We had a 100% response rate on the interviews. There was a mean of 2.2 +/- 1.6 persons per room in the households, with brick houses being less crowded than non-brick houses. Private yards were generally kept very clean. Bucket latrines were unhygienic and used by an average of 4 families. No latrine was built to accepted standards. Garbage collection and emptying of the bucket latrines by the municipality seemed to be unsatisfactory. Our overall impression was that where responsibility for maintenance of hygiene is either undefined, such as the collection chambers of bucket latrines, or a responsibility of the public authorities, such as garbage collection and water drainage, there is an unsatisfactory state of hygiene. Where maintenance of cleanliness is clearly a private responsibility, such as the maintenance of the cleanliness of private yards, the general status of hygiene is good.

Black or African American↗

PubMed1990

Effect of educational intervention on defaecation habits in an Indian urban slum.

The defaecation habits of 172 adults before and after a cholera epidemic in New Delhi in 1988 were investigated. Intensive educational activities were undertaken during the epidemic. A community latrine facility was constructed in this area in February 1988. A greater proportion of females than males were found to be exclusively using the latrines at both rounds of the investigation. A statistically significant relationship with age was observed (P less than 0.001), while literacy was not found to exert a statistically significant effect. Difference in usage habits were more marked in the second round of the investigation. Cost and distance were the main reasons cited for non-utilization of latrines. 91.4% of respondents stated that they had faced some problem in using latrines. Most children were found to be defaecating in the open around the dwelling units at both rounds of the investigation.

Adult↗

PubMed1989

Evaluation of a sanitation programme using eggs of Ascaris lumbricoides in household yard soils as indicators.

Soil samples were analysed for the presence of Ascaris lumbricoides eggs as indicators of environmental pollution in household yards in Maputo, Mozambique, with the objective of evaluating the impact of a programme for the promotion of improved latrine construction. The locations for soil sample collection were defined by a random grid on which household activities were mapped. In addition, parasitological examinations were carried out amongst household residents. No significant difference was found between the type of latrine in use and the presence of Ascaris eggs in the soil or human Ascaris infection. Households with at least one infected person appeared more likely to have Ascaris eggs in the yard. It was notable that egg counts around the latrines were only slightly greater than in other areas of the yard and less than those immediately in front of the dwelling. This is taken to indicate that faecal pollution of the household environment is due more to promiscuous defecation than to poor construction or maintenance of the latrines. The findings highlight the need to complement sanitation 'hardware' with the necessary health education 'software'. Ascaris eggs are useful indicators but robust standardized methods are needed for their extraction from household soils.

Adolescent↗

PubMed1967

Cholera carrier studies in Calcutta in 1966-67.

Cholera carrier studies have been in progress in Calcutta since April 1966, in areas of high endemicity with a population of about 13 000. Carriers are traced through periodic examinations of samples from latrines, users of vibrio-positive latrines, contacts of cases of cholera and apparently healthy persons.The latrine survey showed that 46.2% of the latrines were infected, and brought 54 carriers to light; the over-all carrier rate in the study area was estimated as 1.3%. The carrier rate among household and family contacts of hospital cases of cholera was 1.6%. None of the contacts of 9 persons with choleraic diarrhoea was positive. Vibrios were also isolated from water and flies near positive latrines.The results indicate that carriers can occur even in the absence of overt disease, that infection persists in many households, and that carriers may transmit the infection.

Adolescent↗

PubMed1984

The effect of domestic detergents on the population dynamics of the immature stages of two competitor mosquitoes, Culex cinereus Theobald and Culex quinquefasciatus Say (Diptera, Culicidae) in Kenya.

In some rural areas of Kenya pit latrines are the most important breeding places of Culex quinquefasciatus, but this vector is often rapidly displaced by a competitor, Culex cinereus, which then breeds prolifically in the latrines. In urban settlements, however, cesspools are the main breeding sites of C. quinquefasciatus and no such species replacement occurs. These latter habitats contain water contaminated with domestic detergents. When detergents were introduced into a pit latrine colonized only by C. cinereus this mosquito was eliminated after about 3 weeks. When both species were reared in water containing detergents C. cinereus had lower pupal yields than C. quinquefasciatus. In two pit latrines where C. cinereus normally displaced C. quinquefasciatus, the addition of detergent prevented this, and after their coexistence for a few weeks, C. cinereus eventually disappeared. These observations suggest that during the last few decades domestic detergents, together with other pollutants such as insecticides, may have contributed to the elimination of competitors, such as C. cinereus, from C. quinquefasciatus breeding sites.

Animals↗