Hygiene behaviour can have a greater impact on reducing deaths and disease than the provision of a safe water supply and good toilet facilities. The promotion of hygienic behaviour – especially hand washing – is essential when supplying poor households with safe water and toilets. Do changes in behaviour brought about by hygiene promotion last?

It is estimated that 2.2 million people die each year from poor water supplies, sanitation and hygiene, most of them children under five years old. The Millennium Development Goals specify that by 2015, the global death rate of children under five must be cut by two thirds and many more people should have access to clean water and sanitation. According to research, the promotion of hygiene can change hygiene behaviour. The World Health Organization and UNICEF recommend that hygiene promotion should accompany water and sanitation programmes in the developing world.

A study by the London School of Hygiene and Tropical Medicine, the IRC International Water and Sanitation Centre, Netherlands and the Socio Economic Unit Foundation (SEUF), India, examines whether changed hygiene behaviour is maintained as time passes. It does so by assessing the extent to which SEUF’s socio-economic development programme – which focused on the provision of water and sanitation facilities for and empowerment of, households in poor communities in Kerala, India – brought about long-term changes in the use of newly installed toilets and hand washing behaviour. It also evaluates the impact of each component of the programme on women, men, girls and boys, between two to nine years after the programme had ended.

The study found that the programme’s interventions led to a change in hygiene behaviour and this change was sustained over time. It also made the following findings:

• More than half of the adults reported good hand washing practice, compared to less than 10 percent in a control area.
• The practice of hand washing was not significantly associated with the passage of time since the interventions – up to nine years in some communities – which indicates that behaviour change had taken place and persisted.
• Women recalled taking part in health education classes and this was significantly associated with good hand washing practice, indicating that the classes are an effective part of the intervention.
• The effect of home visits and an awareness campaign on hygiene behaviour was not as significant, but it was found that the home visits had an impact on knowledge.
• Analysis of the impact of interventions on men’s hand washing suggests that this occurred indirectly as most men did not attend the education sessions on health and hygiene, or on maintenance and use of toilets.

The report suggests that changes in hygiene behaviour as a result of such interventions may persist indefinitely. This implies that interventions that promote good hygiene are more cost-effective than was previously accepted, as their benefits may continue for many years. However, the study also recommends that for changes in hygiene behaviour to be fully effective, the interventions must also target men directly, and not only women.

Source(s):
‘What causes sustainable changes in hygiene behaviour? A cross-sectional study from Kerala, India’, Social Science & Medicine 61(10), pages 2212-2220, by Sandy Cairncross et al, 2005
HINARI subscribers can access the full-text article here. Full document.

Funded by: The European Commission and the Netherlands Directorate General for International Co-operation

id21 Research Highlight: 20 April 2006

Further Information:
Sandy Cairncross
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
United Kingdom

Tel: +44 (0) 20 79272211
Fax: +44 (0) 20 76367843
Contact the contributor: sandy.cairncross@lshtm.ac.uk

Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, UK

IRC International Water and Sanitation Centre, Netherlands

Socio Economic Unit Foundation (SEUF), Kerala, India

Other related links:
'Zimbabwe’s community health clubs create demand for better hygiene and sanitation'

'Behaving clean: innovative approaches to hygiene promotion in Burkina Faso and Zimbabwe'

'Hygiene promotion: evidence of efficiency and affordability from Burkina Faso'

'Still clean - do hygiene practices continue after promotion programmes end?'

'Soap: the missing ingredient in the water and sanitation mix'

'Water, sanitation and hygiene: primary concerns for public health'

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