Abstract

PIP: The effects of improving personal and domestic hygiene on diarrhea morbidity are reviewed using data from studies in hospitals, day care centers, and communities. There is evidence that low educational attainment and certain religious customs predispose to diarrhea, presumably because of behavioral factors. The specific hygiene related behavior that has een most studied is handwashing. Hospital studies suggest that enteric infections can spread via contaminated hands and that hands can be decontaminated by washing with soap and water. 3 studies from Bangladesh, US, and Guatemala on the impact of hygiene education programs on diarrhea are reviewed in detail. Reductions in diarrhea incidence rates of between 14-48% were documented in these studies. Little is known of the impact of hygiene education programs on diarrheas of specific etiology or of their impact on diarrhea mortality. Information is lacking on the optimal design of such programs, on costs, and on their dependence on preexisting levels of sanitary facilities. The available evidence suggests that hygiene education programs may be a cost effective intervention for diarrhea morbidity reduction. Research is necessary to fill the current gaps in understanding and to clarfiy the operational aspects of these programs. (author's modified)