Hygiene behaviour in rural Nicaragua in relation to diarrhoea

Abstract

Background: Childhood diarrhoea is a leading cause of morbidity and mortality in Nicaragua. Amongst the risk factors for its transmission are 'poor' hygiene practices. We investigated the effect of a large number of hygiene practices on diarrhoeal disease in children aged <2 years and validated the technique of direct observation of hygiene behaviour.

Methods: A prospective follow-up study was carried out in a rural zone of Nicaragua. From the database of a previously conducted case-control study on water and sanitation 172 families were recruited, half of which had experienced a higher than expected rate of diarrhoea in their children and the other half a lower rate. Hygiene behaviour was observed over two mornings and diarrhoea incidence was recorded with a calendar, filled out by the mother, and collected every week for 5 months.

Results: Of 46 'good' practices studied, 39 were associated with a lower risk of diarrhoea, five were unrelated and only for two a higher risk was observed. Washing of hands, domestic cleanliness (kitchen, living room, yard) and the use of a diaper/underclothes by the child had the strongest protective effect. Schooling (>3 years of primary school) and better economic position (possession of a radio) had a positive influence on general hygiene behaviour, education having a slightly stronger effect when a radio was present. Individual hygiene behaviour appeared to be highly variable in contrast with the consistent behaviour of the community as a whole. Feasible and appropriate indicators of hygiene behaviour were found to be domestic cleanliness and the use of a diaper or underclothes by the child.

Conclusion: A consistent relationship between almost all hygiene practices and diarrhoea was detected, more schooling producing better hygiene behaviour. The high variability of hygiene behaviour at the individual level requires repeated observations (at least two) before and after the hygiene education in the event one wants to measure the impact of the campaign on the individual.

PIP: Poor hygiene practices are among the risk factors for the transmission of childhood diarrhea, a leading cause of morbidity and mortality in Nicaragua. Findings are reported from a prospective follow-up study in rural Nicaragua of the effect of a number of hygiene practices upon diarrheal disease in children under age 2 years old. 172 families, of whom half had experienced a higher than expected rate of diarrhea in their children and the other half a lower rate, participated. Hygiene behavior was observed over 2 mornings and diarrhea incidence was recorded with a calendar over the course of 5 months. Of 46 good practices studied, 39 were associated with a lower risk of diarrhea, 5 were unrelated, and a higher risk was observed for 2. The washing of hands, domestic cleanliness, and the use of a diaper/underclothes by the child had the strongest protective effect against diarrhea. Mothers with more than 3 years of primary school education and in a comparatively better economic position, including having a radio, exhibited comparatively better general hygiene behavior. Education had a slightly stronger effect when a radio was present. However, individual hygiene behavior seems to be highly variable compared to the consistent behavior of the overall community. Appropriate indicators of hygiene behavior were domestic cleanliness and the use of a diaper or underclothes by the child.