Assessment of the impact of a hygiene intervention on environmental sanitation, childhood diarrhoea, and the growth of children in rural Bangladesh
PURPOSE: A community-based hygiene intervention was developed and implemented in 5 villages of lowland Bangladesh 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 defaecation-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.
METHODS: The project area, typical of Bangladesh, was selected because of its poor hygiene and sanitation conditions and its high rates of diarrhoea and malnutrition. 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.
RESULTS: 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 socioeconomic conditions of the households, whereas the intervention site effects were most likely due to the intervention activities.
CONCLUSION: For evaluation of the effect of interventions, the repeat cross-sectional survey may be adequate for estimating relatively stable outcomes such as knowledge and practices, as well as cumulative growth status, but inadequate for fluctuating morbidity.