Hygiene-related Practices Research Articles

Nurses' practices in the preparation and administration of intramuscular injections in mental health: A cross-sectional study.

Intramuscular injections (IMIs) remain a frequent practice in mental health. Few studies have examined the issue of nurses' practices concerning IMI in this domain, and none considered specifically hygiene. Finally, no study appears to have looked at emergency situations and their possible influence on practices. The principal objective of our study was to assess the practices associated with IMI in mental health, especially the hygiene-related practices. The secondaryobjectives were as follows: 1) to assess the practices for the preparation and administration of IMI in mental health for criteria other than hygiene and 2) to determine whether professional experience and emergency situations influence these practices. Single-centre cross-sectional study in a psychiatric Hospital and adherence to the STROBE guidelines. The participating nurses all worked with inpatients, and all volunteered for the study. A self-administered questionnaire was sent to all participants. The questionnaire included questions about knowledge and practices associated with IMI, some considered in two different situations: emergencies and planned injections. The distribution of the responses was tested by the chi-squared test or Fisher's exact test, as appropriate, or by McNemar's chi-squared test or Friedman's nonparametric chi-squared test for matched data. Response rate was 48.6%. Overall, 81% of nurses reported correct handwashing before preparation, 87.5% responded that the dorsogluteal site is currently recommended for IMI, and 74.6% that they did not know the "Z track" technique. In planned injections, 58.7% reported that the choice of needle was determined, at least in part, by the patient's body mass index. In emergency situations, adherence to guidelines was less frequent for all types of practices. This study shows the need to improve practices for the frequently used procedure of IMI among mental health nurses. Better professional education appears necessary to develop optimal practices, especially in emergency situations.

Knowledge and practice on menstrual hygiene among adolescent girls of selected slums in Kathmandu valley

Introductions: Hygiene related practices during menstruationare of considerable importance. This study assesses the existing level of knowledge on menstrual hygiene, and its compliance, among adolescent girls of selected slum areas in Kathmandu, Nepal.
 Methods: Descriptive cross sectional study design was applied and slums in Kathmandu district were selected conveniently as research site. Primary data were collected through interview by using structured questionnaire. The association between knowledge and practices were identified through chi square test.
 Results: There were282 respondents for study. Less than half 121 (42.9%) had adequate knowledge related to menstruation and its hygiene. Two-third 185(65.6%) of the participants used sanitary pads, 183 (98.9%), washed hands after pad change, 271 (96.1%) cleaned perineal area during menstruation, 227(80.5%) were aware about the myth and 61.9% followed social norms and restriction related with menstruation. Age of the participant, their education level and the income sources were found statistically significant with their level of knowledge on menstruation.
 Conclusions: More than half of adolescent girls of slums in Kathmandu district had inadequate knowledge regarding menstruation and two-third practiced menstrual hygiene.

Knowledge and Practice Gap for Menstrual Hygiene among Adolescent School Girls of Tribal District of Maharashtra, India: A Cross Sectional Study

Introduction: Hygiene-related practices of adolescents during menstruation are of importance, as poor hygiene might increase vulnerability to reproductive tract infections (RTI). Therefore, increased knowledge about menstruation right from childhood may escalate safe practices and may help in mitigating the suffering of women. Aims and Objectives: (1) To assess the knowledge and practices about menstrual hygiene among school going adolescent girls. (2) To evaluate health seeking behaviour among the study subjects. Methodology: This was a cross sectional study done in three randomly selected Government High Schools in tribal District Palghar from Jan-Feb 2018. A pre-designed, pre-tested and structured questionnaire was used. Data were compiled in an Excel sheet and were analysed by using EPI info statistical software (version2.3.1). Results: A total of 277 girls were interviewed, the mean age was 14 years. Majority of girls were aware about menstruation prior to the attainment of menarche. Mothers were first informant in about 69.6% girls. But correct reason and source of bleeding was not known to most of respondents. Overall 63.8% adolescent girls were using sanitary napkins as menstrual absorbent while 36.1%were using old used cloth and 13.7%were using both. Conclusion: There is need to educate the girls about menstruation, its importance and hygiene maintenance so as to enable them to have healthy and productive life in future.

A cross-sectional study on menstrual hygiene practices among school going adolescent girls (10-19 years) of Government Girls Inter College, Saifai, Etawah

Background: Menstrual hygiene is a key concern of adolescent health. Females spend around six to seven years of their lives menstruating. Still the menstrual hygiene management (MHM) is mostly neglected. Menstrual hygiene is a taboo; even females are uncomfortable discussing and educating their daughters about this topic. To understand the problem faced by females during menstruation specially in their adolescent age this study was conducted. This study was done to find out knowledge about menstrual hygiene, to study hygiene related practices among school going adolescent girls of Government Girls Inter College (GGIC), Saifai, Etawah.Methods: School based cross-sectional study was undertaken among the adolescent school going girls of GGIC, who were purposively selected. All girls of between the age group of 10 19 years who have attained menarche were selected and the sample size came out to be 212.Results: The mean age of attainment of menarche was 13.17 years with majority of girls having no idea about menstruation before menarche (76.4%). 48.6% girls used only sanitary pads as the absorbent material. It was concluded that there is significant association between the absorbent material used and the socio-economic status of the family (p=0.03173).Conclusions: There is a need of accurate and adequate information about menstruation and its effective management. The restrictions which are imposed on girls during menstruation should be understood and dealt in a proper way. Thus this study was conducted.

Assessment of knowledge and menstrual hygiene management among adolescent school girls of Nelamangala

Background: Menstruation is a physiological process but generally it is considered as unclean in the Indian society. Hygiene related practices of menstruation are of considerable importance as it has health impact in terms of increased vulnerability to reproductive tract infections (RTI) and drop outs from school. A good knowledge regarding menstrual hygiene is important during adolescence age which helps to practice good hygiene, minimize the sufferings of women and to manage their menstruation without any hesitation.Methods: A cross sectional study was undertaken in a rural field practice area of BMCRI, Bengaluru. Data was collected from 311 adolescent girls by using predesigned semi structured questionnaire.Results: It was evident that 38.3% participants were aware about menstruation before their menarche and among them; mothers were the main source of the information for 72.3% girls. It was found that 80.4% respondents used sanitary pads and 73.6% girls did not have practice of changing the adsorbent in the school. Only 27.7% had the practice of changing ≥4 pads/cloths per day during the menstruation. Majority of the girls were restricted to enter the place of worship (73.3%) and to attend the religious functions (41.5%) and also restriction to eat certain food items among 20.3% girls. There was a significant association between the religion and the frequency of changing the adsorbent and cleaning the external genitalia during the menstrual period.Conclusions: This study could found that majority of the girls had no information about menstruation before menarche. Menstrual hygiene management (MHM) was very poor.

Perceptions and practices about menstrual hygiene among women of reproductive age group (15-49 years) attending out-patient department of CIMS, Bilaspur Chhattisgarh

Background: Women suffer due to their ignorance on hygienic requirement during menstruation. Hygiene related practices of women during menstruation are of considerable importance, as it has a health impact in terms of increased vulnerability to RTI. Inthis paper our objectives is to detect the menstrual health problems and to assess menstrual hygiene practices among women of reproductive age group (15-49 years) attending OPD of CIMS Bilaspur Chhattisgarh (Obstretic and Gynaecology, OPD).Methods: Females of reproductive age group (15-45 years) attending routine obstretics and gynaecology OPD during 1st May to 15th September 2015 were included in the study after taking their verbal consent at CIMS hospital. Pretested semi-structured questionnaire were used to take history regarding knowledge and practices related to menstrual hygiene. Statistical test like chi-square test were applied using Epi info 7 software.Results: 36% of study population belonged to the 21-30 year age group. About 75% were married. Majority of women had primary education (43.3%) and 54.3% belonged to lower middle class. Majority of women 51.8% used cloth during menstruation; about 45.7% used the same cloth by washing and reusing every month.Conclusions: Most women were found to follow unhygienic practices. Hence, efforts such as improving female literacy and health education regarding the various risk factors should be made by the policy makers to increase menstrual hygiene among rural population. Literacy status was found to be significant for awareness about menstruation and the use of sanitary pads.

Cosmetic surgery advertising exposure, attitudes toward the surgery and surgeons, and perceptions of the advertisement features

ABSTRACTIntroduction: Empirical research on cosmetic surgery advertisements is scarce, in spite of their increasing visibility and ensuing ethical controversies. In the current study, the effects of cosmetic surgery advertising on perceived benefits, risks, acceptance of cosmetic surgery and attitudes toward cosmetic surgeons were examined. Additionally, audience perceptions about the information utility of 27 common elements of cosmetic surgery advertisements were inquired.Method: A web-based cross-sectional survey was conducted with a convenience sample of 343 college students.Results: Exposure to cosmetic surgery advertisements was positively related to perceived benefits and surgery intention, but not related to perceived risk. Compared with doctors in general, cosmetic surgeons were trusted less, though exposure to cosmetic surgery advertisements improved some perceptions about cosmetic surgeons. Among the 27 elements examined, surgeon's education and training, price, financing options, before-and-after photos of patients, patient testimonials, surgeries/procedures available, risks of surgeries/procedures, hygiene-related practices, medical emergency preparedness, and consultation information were rated as helpful. Rated as not helpful were surgeon's portrait photos, office staff photos, highly attractive model photos, after-only photos of actual patients, and celebrity cosmetic surgery information. There were also differences in the evaluation of the 27 elements based on the level of cosmetic surgery advertising exposure and perceived risk.Conclusions: The findings justify marketing efforts of cosmetic surgeons. At the same time, the evaluation of cosmetic surgery advertising elements revealed many areas of confusion among consumers and thus warrants further research and education.

"Koko et les lunettes magiques": An educational entertainment tool to prevent parasitic worms and diarrheal diseases in Côte d'Ivoire.

BackgroundIntegrated control programs, emphasizing preventive chemotherapy along with health education, can reduce the incidence of soil-transmitted helminthiasis and schistosomiasis. The aim of this study was to develop an educational animated cartoon to improve school children’s awareness regarding soil-transmitted helminthiasis, diarrheal diseases, and related hygiene practices in Côte d’Ivoire. The key messages included in the cartoon were identified through prior formative research to specifically address local knowledge gaps.MethodologyIn a first step, preliminary research was conducted to assess the knowledge, attitudes, practices, and beliefs of school-aged children regarding parasitic worm infections and hygiene, to identify key health messages to be included in an animated cartoon. Second, an animated cartoon was produced, which included the drafting of the script and story board, and the production of the cartoon’s initial version. Finally, the animated cartoon was pilot tested in eight selected schools and further fine-tuned.Principal findingsAccording to the questionnaire results, children believed that the consumption of sweet food, eating without washing their hands, sitting on the floor, and eating spoiled food were the main causes of parasitic worm infections. Abdominal pain, diarrhea, lack of appetite, failure to grow, and general fatigue were mentioned as symptoms of parasitic worm infections. Most of the children knew that they should go to the hospital for treatment if they experienced symptoms of parasitic worm diseases. The animated cartoon titled “Koko et les lunettes magiques” was produced by Afrika Toon, in collaboration with a scientific team composed of epidemiologists, civil engineers, and social scientists, and the local school children and teachers. Pilot testing of the animated cartoon revealed that, in the short term, children grasped and kept key messages. Most of the children who were shown the cartoon reported to like it. Acceptance of the animated cartoon was high among children and teachers alike. The messaging was tailored to improve knowledge and practices for prevention of helminthiases and diarrheal diseases through prior identification of knowledge gaps. Integration of such education tools into the school curriculum, along with deworming campaigns, might improve sustainability of control and elimination efforts against helminthiases and diarrheal diseases.

Water, Sanitation, and Hygiene Facilities and Hygiene Practices Associated with Diarrhea and Vomiting in Monastic Schools, Myanmar

Gastrointestinal diseases are major contributors to mortality among children globally, causing one in 10 child deaths. Although most deaths are in children aged ≤ 5 years, the burden of disease in school-aged children is still considerable and contributes to high rates of school absenteeism. This study investigates behavioral and structural risk factors associated with diarrhea and/or vomiting among schoolchildren in Myanmar. Cross-sectional data from a school-based multistage cluster sample of grade 4 and 5 students were analyzed to explore water, sanitation, and hygiene (WASH) facilities and hygiene-related practices of students in monastic schools in Myanmar. The outcome of interest was student self-reported diarrhea and/or vomiting in the past week. Random effects multinomial logistic regression models were used to explore correlates at the student and school level. A total of 2,082 students from 116 schools across eight states/regions were included. Of these, 11% (223) self-reported at least one episode of diarrhea only, 12% (253) at least one episode of vomiting only, and 12% (244) diarrhea and vomiting in the past week. Independent risk factors associated with the outcome included poor availability of handwash stations, no access to a septic tank toilet, inconsistent toilet use, and lower student grade. These findings highlight the importance of having an adequate number of handwash stations for students, the provision of septic tank toilets, and consistent toilet use. Future WASH programs need to target not only the provision of these WASH facilities but also their utilization, particularly among younger school-aged children.

Avaliação das práticas de adesão à higienização das mãos relacionadas com linhas vasculares em uma Unidade de Terapia Intensiva

The study aimed to evaluate the compliance and non-compliance of the intensive care unit staff with regard to hand hygiene practices when placing intravascular lines to prevent bloodstream infections related to central venous catheter placement. This was an observational study with a quantitative approach. The study was based on 892 reviews obtained through direct observation using the Manual of Quality Evaluation of Hospital Infection Control Practices of the State Secretariat of Health of Sao Paulo. The results revealed that the general compliance index for hand hygiene-related practices was null, indicating low levels of individual compliance; this was especially observed with regard to the practice of hand hygiene before and after the change of the intravascular lines, which had the lowest rate of compliance of all observed practices (10.3%). The practice of sanitizing the hands before and after blood collection had the highest compliance rate (36.1%). There is a need for developing strategies that ensure the adherence to infection control and hand hygiene practices to prevent bloodstream infections related to central venous catheter placement, as well as for instituting periodic assessments of working conditions to raise the rates of compliance.

Water and sanitation hygiene knowledge, attitudes and practices among school settings in rural Chennai

This pilot cross-sectional study was conducted to assess water and sanitation hygiene-related knowledge, attitude and practices (KAP) among rural school students in Chennai, South India in September 2013. A convenient sample of 80 participants (70 children and 10 staff members) was enrolled in the study. The inclusion criteria included participants residing in rural areas and studying in a government school. A semi-structured questionnaire was used to assess sociodemographic and school characteristics and water and sanitation hygiene (WASH)-related KAP. The mean age of the students was 14 years (SD = 2) and half of them were females. The school had a government drinking water supply and did not use any water treatment/purification method. The majority of the participants had correct WASH-related knowledge. However, one-third of the students reported diarrheal episodes in the school due to unsafe drinking water. There was disparity in the response of the students compared to the staff about toilet facilities in the school. This study concluded that there is a need for multifaceted intervention that will facilitate adequate water and sanitation hygiene practices among school children through the availability of proper sanitation infrastructure and family-centered education.

Knowledge and Practices of Menstrual Hygiene among Married Adolescents and Young Women in Chittoor District Of Andra Pradesh: India

Background: Adolescent girls often lack knowledge regarding reproductive health including menstruation which can be due to socio-cultural barriers in which they grow up. The menstrual hygiene related practices of female in the adolescence period can have effect on their health. Issues associated with menstruation are never discussed openly and this burdens adolescent girls by keeping them ignorant of this biological function. Among the various sub groups of women, reproductive health of married adolescence and young women is of crucial and especially in a state like Andhra Pradesh. Aims and Objectives: To assess the knowledge and practices of menstrual hygiene among married adolescent and young women. Methods and materials:The present study was conducted among 400 married adolescent and young women who are in the age group of 15-25 years, residing in Tirupati division, Chittoor district, Andhra Pradesh. A community based cross sectional study was conducted in 4 mandals of tirupati division. The subjects were selected randomly from the eligible couple registers available with the health workers. The interview technique was used to collect the data with the help of pre-designed, pre-tested questioner prepared by the investigator. Results : The average of the respondent is 19.6 years and average age at menarchy was 13.2 years. The mean scours of respondents’ menstrual hygiene is observed to be significantly (p<0.01) very high among those who belong to nuclear families than among those from joint families. It is further, conspicuous to note that the differences in mean scores of menstrual hygiene across respondents’ and spouses’ level of educational attainment turn out to be highly significant (p<0.01 and p<0.01, respectively). level of menstrual hygiene appear to be increasing (significant at moderate level; p<0.05) with an increase in time spent on watching TV / listening to radio. It is also interesting to note that the average level of menstrual hygiene of those respondents who marred their blood relatives is found to be higher (and moderately significant; p<0.05) than those who married with non-blood relatives. On the other hand, the mean score of menstrual hygiene appear to be marginally lower among those who are adhering to large number of restrictions during menstruation than those who are following small number of such restrictions. Conclusion: Many factors are known to affect menstrual hygiene along with education and occupation of married adolescent/young woman and her spouse. There is a need of adolescent girls to get adequate information about healthy menstrual practices. The medical health care personal have to organize village level/urban slum level meetings/camps to interact with married adolescent and young women to increase their awareness on menstrual hygiene. Most of the adolescent and young women were not consumed balanced diet due to food restrictions and taboos during menstruation. Hence, it is suggested to conduct extensive nutrition educational programmes along with health education by the health functionaries.

Menstrual Hygiene: Knowledge and Practice among Adolescent School Girls In rural areas of West Bengal

Menstruation is generally considered as unclean in the Indian society. Isolation of the menstruating girls and restrictions being imposed on them in the family, have reinforced a negative attitude towards this phenomenon. There is a substantial lacuna in the knowledge about menstruation among adolescent girls. Although menstruation is a natural process, it is linked with several misconceptions and practices. Hygiene-related practices of women during menstruation are of considerable importance, as it has a health impact in terms of increased vulnerability to reproductive tract infections (RTI). Good hygienic practices such as the use of sanitary pads and adequate washing of the genital area are essential during menstruation. Menstrual hygiene and management will directly contribute to the Millennium Development Goal (MDG)-2 on universal education and MDG -3 on gender equality and women empowerment.

Factors Leading to Poor Water Sanitation Hygiene Among Primary School Going Children in Chitungwiza.

Although the world has progressed in the area of water and sanitation, more than 2.3 billion people still live without access to sanitation facilities and some are unable to practice basic hygiene. Access to water and basic sanitation has deteriorated in Chitungwiza and children are at risk of developing illness and missing school due to the deterioration. We sought to investigate the predisposing, enabling and reinforcing factors that are causally related to water- and sanitation- related hygiene practices among school going children. A random sample of 400 primary school children (196 males, 204 females) in four schools in Chitungwiza town, Zimbabwe was interviewed. Behavioural factors were assessed through cross examination of the PROCEED PRECEDE Model. The respondents had been stratified through the random sampling where strata were classes. A structured observation checklist was also administered to assess hygiene enabling facilities for each school. Children’s knowledge and perceptions were inconsistent with hygienic behaviour. The family institution seemed to play a more important role in life skills training and positive reinforcement compared to the school (50% vs 27.3%). There was no association between a child’s sex, age and parents’ occupation with any of the factors assessed (P=0.646). Schools did not provide a hygiene enabling environment as there were no learning materials, policy and resources on hygiene and health. The challenges lay in the provision of hygiene enabling facilities, particularly, the lack of access to sanitation for the maturing girl child and a school curriculum that provides positive reinforcement and practical life skills training approach.

India Moves Towards Menstrual Hygiene: Subsidized Sanitary Napkins for Rural Adolescent Girls—Issues and Challenges

The onset of menstruation is one of the most important physiological changes occurring among girls during the adolescent years. Menstruation heralds the onset of physiological maturity in girls. It becomes the part and parcel of their lives until menopause. Apart from personal importance, this phenomenon also has social significance. In India, menstruation is surrounded by myths and misconceptions with a long list of "do's" and "don'ts" for women. Hygiene-related practices of women during menstruation are of considerable importance, as it may increase vulnerability to Reproductive Tract Infections (RTI's). Poor menstrual hygiene is one of the major reasons for the high prevalence of RTIs in the country and contributes significantly to female morbidity. Most of the adolescent girls in villages use rags and old clothes during menstruation, increasing susceptibility to RTI's. Adolescents constitute one-fifths of India's population and yet their sexual health needs remain largely unaddressed in the national welfare programs. Poor menstrual hygiene in developing countries has been an insufficiently acknowledged problem. In June 2010, the Government of India proposed a new scheme towards menstrual hygiene by a provision of subsidized sanitary napkins to rural adolescent girls. But there are various other issues like awareness, availability and quality of napkins, regular supply, privacy, water supply, disposal of napkins, reproductive health education and family support which needs simultaneous attention for promotion of menstrual hygiene. The current article looks at the issue of menstrual hygiene not only from the health point of view, but also considers social and human rights values attached to it.

Colonization with Staphylococcus aureus and Methicillin-Resistant S. aureus among a Sample of Homeless Individuals, Ohio

Colonization with <i>Staphylococcus aureus</i> and Methicillin-Resistant <i>S. aureus</i> among a Sample of Homeless Individuals, Ohio

Psychosocial and Demographic Factors Related to Health Behaviors in the 1st Trimester

To explore the relationship of psychosocial and demographic variables to health behaviors in early pregnancy. First trimester findings presented from a prospective study of weight gain in pregnancy. A comprehensive health care system in central Texas. 114 pregnant women (75% white, 13% African American, 10% Hispanic, 2% Asian) of 12 weeks gestation or less. Self-Care Inventory, which includes diet/eating, substance abuse, recklessness, hygiene-related practices, sleep/rest, and exercise behaviors. In regression analysis the final model of demographic and psychosocial variables showed that higher depressive symptoms, lower internal locus of control for fetal health, and lower family income were related to poorer health behaviors in the 1st trimester of pregnancy. Health behaviors in early pregnancy may be affected by psychosocial factors such as depressive symptoms. Greater emphasis should be given to such factors in research and prenatal assessments.

An interdisciplinary and systems-based evaluation of academic programs: Bovine mastitis-related veterinary research, education and outreach

An interdisciplinary and systems-oriented approach for evaluation of academic programs was explored in veterinary research, education and extension in the context of prevention of bovine mastitis. Bibliometric-based document analysis and observation methods were used to assess disciplinary contents of veterinary research and graduate education theses, and New York State dairy farmers' adoption rate of selected veterinary recommendations (bacteriological testing of raw milk, “closed herds”, and three hygiene-related practices). Findings indicated that: a) the veterinary extension literature was lower in output and less differentiated in disciplinary content than that of the agricultural counterpart; b) three disciplines accounted for 85% of all theses major contents; and c) 39.7% of New York dairies requested bacteriological testing, 50% of investigated dairies had “closed herds” and at least 9.4% of those did not adopt all the hygiene-related practices. Context-specific recommendations are proposed. It is concluded that this evaluation approach may facilitate policy analysis, program development and may be applicable to other academic settings.

AWARENESS OF PROBLEMS DUE TO MENSTRUATION IN SCHOOL GOING GIRLS - HYDERABAD SINDH

Background: Menstruation is a major stage of puberty in girls, one of the many physical signs that a girl is turning into a woman. Women having better knowledge about menstrual hygiene and safe practices are less vulnerable to RTI and its consequences. Therefore, increased knowledge about menstruation right from childhood may escalate practices and may help in mitigating the suffering of millions of women. This study carried out to gather information regarding menstruation, hygiene related practices and its related problems among adolescent girls along with to review perceptions, belief and expectations regarding menstruation among adolescent girls. Methods: A Cross-sectional study was conducted, 314 girls of 12 to 15 years were identified as sample from 5 girls high schools. Pre tested pre designed questionnaire was used. Data were analyzed by using SPSS (Version 22). Descriptive statistics used to determine mean age of the subjects, age at menarche, frequency of menstrual disorders and activities affected by this condition. Results: Mean age of the sample was 14.25 years, with mean age of menarche 12.6 years. 52.6% of the girls belong to the mothers who are illiterate. 50.7% girls were aware of menstruation before menarche with major source of the information is mother (71.2%). 97.8% perceived menstruation as a normal process. 55.1% participants said they missed their school during menstruation. 96.4% experiencing pain and cloth was most common source of absorbent used by 60.2%. Conclusion: Mothers are the main source of information for young girls. Major reason for absenteeism from school was fear of stain, it has been suggested through cleanliness available for changing absorbent (pad/cloth) the ratio of absenteeism can be reduce.

A Method of Health Culture Research in an African Country

Public health programming in a foreign culture requires attention to two main facets of the problem: (1) introduction of good practices of modern, decentralized, preventive medicine; and (2) of the ecological conditions that exist prior to the planned change. The latter involves determination of epidemiology, human geography, pre-scientific attitudes and practices relating to health and sickness, ethno-cultural factors in the aspirations of the various population groups. The first facet can be solved by techniques developed in the field of p u b 1 i c health: allocation of funds; recruitment of instructors, administrators and equipment; and substitution of para-medical trainees in regions where the availability of fully-qualified physicians, nurses, and sanitary engineers for rural needs is a decade away. The solution to the second facet requires teamwork among several disciplines because of the interlacing of biological and cultural dimensions. This paper will outline a recent enterprise which was in part modelled on Dodd's controlled experiment on rural hygiene thirty years ago,4 but which required adaptation from the problems of Syria a generation ago to those of Ethiopia today. In both regions, experimental and controlled communities were selected, and arbitrary scores assigned to hygiene-related practices and attitudes. This paper describes the before part of the enterprise. The Ethiopian Context: The concept of decentralization of the introduction of modern health center facilities immediately directs the attention to the rural region where the majority of people live, in developing countries.5 Unlike Syria, Ethiopian rural folk live in series of hamlets rather than villages, but group around market centers. The latter take the aspects of little towns and vary in population from 1,000 to 4,500 residents. Since the introduction of health facilities requires accessability at least most of the year, the little towns constituted the most logical universe from which sample study and control communities were to be selected in such a manner as to represent the major ethnic and ecological dimensions of the country. Ethiopia was considered a good location for such a because true baselines exist due to the long isolation of the country and poor communications among many of the communities.