Community-based hygiene education to reduce diarrhoeal disease in rural Zaire : a prospective, longitudinal study

Abstract

A randomized, controlled trial of an educational intervention to improve personal and domestic hygiene practices and to reduce diarrhoeal morbidity was conducted in Bandundu, Zaire. Oiarrhoeal histories of 2082 weaning aged children living in 18 village clusters (sites) were obtained between October and December 1987, and structured observations of hygiene behaviours associated with food preparation, meal sharing, child feeding, child defecation, and yard cleanliness were made in 300 randomly selected sentinel families. This baseline information was used to design a non-formal educational intervention. The intervention was implemented by trained community volunteers for 6 months beginning in July 1988. A second diarrhoeal and second observational study were conducted between October and December 1988, in order to evaluate the intervention. After the intervention, children in intervened sites had an 11% lower risk of diarrhoea (p<.025), fewer days of diarrhoea (p<.025), and shorter durations of episodes (p=.04) than control children, and the largest differences were among children aged 24-35 months. Diarrhoeal reductions were positively associated with community volunteer performance and hence, intervention quality, in all sites. Hygiene practices, post-intervention, were significantly better among intervened compared to control sentinel families. Preventive behaviours were practised much more frequently after the intervention than before, in both study groups, however the improvements among intervened families were substantially greater, leading to the conclusion that the intervention was responsible for about a 10% reduction in bad behaviour. Behavioural improvements were positively associated with diarrhoeal reductions, after controlling for child age, and with intervention quality in all sites. Children in intervened sites had higher mean W/A z-scores at the end of the intervention than control children (p<.05), with children aged 24-35 months appearing to benefit most. The post-intervention change in children's W/A, from October-December 1988, was larger among intervened than control children (p<.0003), and from pre- to postintervention, the change in W/A (October-December) improved significantly more among intervened than control children. Improvements in child growth corresponded to diarrhoeal reductions and to the quality of intervention in sites. In suonry, the results of the study suggest that a non-formal, community-based educational intervention to improve personal and domestic hygiene behaviour may be an effective strategy to reduce childhood diarrhoea in Zaire.