Assessment of the impact of a hygiene intervention on environmental sanitation childhood diarrhoea and the growth of children in rural Bangladesh.

Poor hygiene and sanitation are major contributors to diarrhea leading to malnutrition and child mortality. In Bangladesh 90% of preschool children suffer from some degree of malnutrition. Selecting a project area in lowland Bangladesh because of its poor hygiene and sanitation conditions and its high rates of diarrhea and malnutrition the authors developed and implemented a community-based hygiene intervention in five villages with the objective of reducing the level of childhood diarrhea by altering ground sanitation and personal and food hygiene practices such as the washing of hands with ash before handling food and after defecation-related activities cutting fingernails removing feces from childrens bodies and yards using tube-well water to prepare baby food and reducing supplementary feeding contamination by the proper cleaning of bottles or avoiding bottle-feeding. Households were targeted with children aged 0-18 months while a comparison site was observed without intervention. Baseline surveys were undertaken on the subset of households with children 9-18 months at the control site in July 1985 and at the intervention site in September with intervention activities conducted over the period January-July 1986. The final survey was then conducted at both sites in August 1986. Although both sites were cleaner with lower levels of diarrheal morbidity and better growth status at the end of the study period 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 household socioeconomic conditions while the intervention site effects were most likely due to the intervention activities.