Hygiene behaviour and hospitalized severe childhood diarrhoea: a case-control study

Abstract

The relationship between personal and domestic hygiene behaviour and hospitalized childhood diarrhoea was examined in a case-control study of 356 cases and 357 controls from low-income families in metropolitan Manila. Indices of hygiene behaviour were defined for overall cleanliness, kitchen hygiene, and living conditions. Only the indices for overall cleanliness and kitchen hygiene were significantly associated with diarrhoea. An increasing excess risk of hospitalization with severe diarrhoea was noted as the ratings for standards of hygiene became lower, and this excess risk persisted even after controlling for confounding variables. The implications of our findings for the control of diarrhoeal disease are discussed.

PIP: Between April and October, 1989, professors from the College of Public Health at the University of the Philippines in Manila compared data on 356 5-year-old children living in Manila, who had been admitted to a government hospital with diarrhea of 7 days duration, with data on 357 age and neighborhood matched controls to study the relationship between personal and domestic hygiene behavior and hospitalized severe childhood diarrhea. To address selection bias, the researchers chose controls who could potentially use the hospital services. All the children were from low-income families. As standards of hygiene for overall cleanliness and kitchen hygiene fell, the risk of severe diarrhea increased. Specifically, children in the group with a middle score in overall cleanliness acquired severe diarrhea at 2 times the rate as those with a low score (i.e. better hygienic conditions). Those in the high score group acquired it at 3.9 times the rate as those in the low score group. For kitchen hygiene, the odds ratios were 2.7 and 5.3, respectively. Living conditions did not influence the rate of diarrhea. Living conditions included inside and outside sanitary conditions, number of rooms, and presence or lack of a dining table. These findings suggested that effective health education programs aimed to change hygiene behavior could prevent severe diarrhea. Therefore, public health programs should develop suitable interventions for the education of mothers and of the general public.