Poor hygiene and diarrhoea: reducing the risk in the Kyrgyz Republic

Diarrhoeal disease is the second most common cause of death in children globally and the source of an estimated 2.2 million child deaths in 2000 alone. What hygiene practices in poor households in the Kyrgyz Republic negatively affect public health? What implications do they have for hygiene intervention programmes?

The Kyrgyz Republic gained independence from the former Soviet Union in 1991 and since then, it has suffered economic decline. Many Kyrgyz people live in poverty in villages that have inadequate water supply and poor sanitation infrastructure. They also have poor access to health services. As a result, diarrhoea is likely to be a significant health problem and is highly likely to contribute to the country’s high infant death rate of 77 per 1,000 live births (in 2000). Reducing the risk factors for diarrhoea could reduce infection and lengthen children’s lives.

A study by the UK Government’s Department for International Development (DFID) looks at domestic hygiene and sanitation practices in homes of the poorest people in six villages in the Kyrgyz Republic. It focuses on two aspects of behaviour that are among the most critical to address: how infant’s and children’s faeces are disposed of, and handwashing with soap after possible contact with faeces and before handling food.

The study found that hand washing with soap is probably not the normal practice, but hand washing with water is more common. It also made the following findings:

• Almost all households have sanitation facilities (pit latrines) and it is standard practice for adults to use these facilities.
• The contamination of the home environment with children’s faeces is a health threat resulting from two factors: it is seen as acceptable to dispose of children’s faeces in the yard and sanitation facilities are difficult and potentially dangerous for young children to use.
• Soap is available in most households but is used mainly for laundry and to get rid of visible dirt from hands.
• The household’s ownership of a washstand appears to be associated with increased handwashing after use of the toilet.

It is likely that due to the Soviet Union’s economic decline and that of the emerging republics, many millions of people are battling with an inadequate public health infrastructure. If this is so, a response to the situation is critical.

The findings have a number of implications for health interventions:

• If safe handwashing practices are to be encouraged, a number of factors may need to be addressed, such as provision of a convenient water source and the cost and uses of soap in the household.
• Whether or not the ownership of a washstand encourages hand washing needs to be investigated further. Although many households cannot afford current models, cheap and widely available washstands might play an important role in safer hand washing.
• A strategy that promotes the safe disposal of children’s faeces and promotes affordable improvements to latrine facilities to make them safer and more pleasant to use.
• Potties could be promoted as a method for disposing of infant’s faeces more hygienically.
• Young children and their mothers should be the primary targets in the intervention as they play the most direct role in keeping the home environment free of faecal contamination.

Source(s):
‘Formative research for hygiene promotion in Kyrgyzstan’, Health Policy and Planning 20(4), pages 213-221, by Adam Biran, Anara Tabyshalieva and Zumrat Salmorbekova, 2005
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Department for International Development (DFID) through the WELL Resource Centre http://www.lboro.ac.uk/well/

id21 Research Highlight: 25 April 2006

Further Information:
Adam Biran
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
United Kingdom

Tel: +44 (0) 20 76127862
Fax: +44 (0) 20 76367843
Contact the contributor: adam.biran@lshtm.ac.uk

UK Department for International Development (DFID)

Other related links:
'Reducing diarrhoea: what works best?'

'Flushing out worm infections – the benefits of better sanitation'

'Solving the sanitation crisis'

UNDP: Central Asia Human Development Report 2005

'Beyond the source: keeping water clean in developing countries'

'Waste disposal - local information makes hygiene promotion more effective'

'Zimbabwe’s community health clubs create demand for better hygiene and sanitation'