Effect of hygiene measures water sanitation and oral rehydration therapy on diarrhea in children under five years old in southern Ivory Coast

Children under 5 years of age living in four Ivory Coast villages about 70 km from Abidjan were studied before and after two of the villages were provided with potable water latrines and education for diarrhea prevention and oral rehydration treatment. The objective was to determine the impact of these programs on the incidence of diarrhea in young children. The combined population was 4738 in the two test villages and 4394 in the two control villages. Mothers of under-5 children were surveyed in their homes concerning diarrhea episodes in the preceding 2 weeks. The numbers of diarrhea episodes per child and per year were estimated using the WHO coefficient of seasonality which was 0.07 in this region for the study period. Questions were included on the deaths of under-5 children in the preceding year. 560 children in the test villages and 700 in the control villages were studied in 1988. In 1990 and 1992 respectively 327 and 474 children in the test villages and 658 and 650 children in the control villages were surveyed. In the test villages the proportions utilizing hygienic practices such as covering drinking water and not storing it for more than 24 hours increased significantly. The incidence rate of diarrhea in the test villages decreased from 32% in 1988 to 16% in 1992 a 50% decline. No significant variation was observed in the control villages whose incidence rates were 24% in 1988 and 25% in 1990 and 1992. The proportion of children with diarrhea treated with oral rehydration increased significantly in the test villages from 8% to 39% but did not change significantly in the control villages. The proportion of deaths associated with diarrhea declined significantly in the test villages from 27% to 4% but did not significantly change in the control villages. Likewise the mortality rate associated with diarrhea declined significantly in the test villages from 5.3% to 0.8% but did not change significantly in the control villages.