Toilet training - preventing childhood diarrhoea through hygiene promotion programmes

Hygiene promotion figures prominently in diarrhoea prevention programmes throughout the developing world. But do these programmes produce real changes in behaviour? Research by the London School of Hygiene and Tropical Medicine examines the impact of a large-scale hygiene promotion programme in Bobo-Dioulasso, Burkina Faso.

Mothers of small children in Burkina Faso see hygiene as aesthetically and socially desirable. How can programme planners exploit this positive motivation to reduce childhood diarrhoea? The study found that hygiene promotion programmes can significantly influence behaviour if they are based on local formative research and use appropriate channels of communication.

Diarrhoea is responsible for the deaths of over three million children a year in developing countries. Changes in human behaviour can substantially reduce the incidence of diarrhoeal disease. Thus, hygiene promotion is potentially one of the cheapest and most effective means of disease prevention. However, changing human behaviour is a complex and uncertain process.

This three-year hygiene promotion programme was aimed at mothers and carers of infants and children of primary school age. It used novel strategies to target specific risk practices: failure to wash hands with soap after stool contact and inadequate disposal of children's stools. The survey showed that there was significant improvement in hygiene as a result of the programme. Changes in behaviour were greatest in populations where hygienic practices were initially uncommon. Other key findings include:

• Half of the mothers could cite correctly the two main messages of the hygiene programme.
• There was an increase in hand washing with soap after cleaning a child’s bottom.
• Mothers also washed their hands with soap more frequently after using the latrine themselves.
• Use of plain water for hand washing more than doubled over the study period.
• However, there was little improvement in the safe disposal of children's stools.

The researchers suggest that hygiene promotion programmes could be made more effective by:

• building them on existing local culture and practices
• identifying the wishes of the target audiences
• using locally appropriate channels of communication
• repeating the messages over an extended period of time
• monitoring success and retraining staff.

Source(s):
‘Evidence for behaviour change from hygiene promotion programme in West Africa’ by V. Curtis et al., Bulletin of the WHO 79 (2001) Full document.

Funded by: UNICEF

id21 Research Highlight: 15 August 2001

Further Information:
Val Curtis
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7927 2628
Fax: +44 (0)20 7636 7843
Contact the contributor: val.curtis@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
WHO has resources relating to childhood diarrhoea.

The Partnership for Child Development promotes the health, nutrition and education of school-aged children.

UNICEF's State of the World's Children report is now on-line.

Child Health Dialogue is Healthlink Worldwide's newsletter on child health and disease prevention.