Prevention of diarrhoea in rural Bangladesh: evaluation of an intervention for hygiene behaviour change

Abstract

Objective: Evaluate the SAFE Pilot Project, an intervention to change hygiene behaviour implemented by CARE Bangladesh. Methods: This intervention took place in rural Chittagong, southeastern Bangladesh. Priorities and interventions were developed for hygiene behaviour change based on initial quantitative and qualitative studies. Two models of participatory extension were compared: Model 1 represented a "limited model" working through community meetings organized by tubewell caretakers; and Model 2 represented an "expanded model" working through caretaker groups plus school programmes, child to child activities, and key community persons. The baseline and final surveys took place in May 1993 and May 1994 respectively. Baseline and final cross-sectional survey data were compared in the two intervention areas and two contiguous control areas. Subjects for this analysis were from 720 households in 120 tubewell-user areas (180 households in each of the 4 study areas), respondents (mothers), and other family members as reported by the respondents. The main outcome measures were observed, demonstrated, and reported hygiene behaviours of the respondent and other family members. Reported two-week and 24-hour diarrhoea prevalence rates in children of less than 5 years were also used. Results: The baseline survey of the four study areas showed that there was initially no significant difference between the intervention and the control areas. Access to hygienic latrines and latrine use was poor, knowledge of the causes of diarrhoea and of prevention was low, and hand-washing behaviour was poor. Environmental contamination with faeces and diarrhoea rates in children of less than 5 years were high. The final survey, after nine months of SAFE intervention, showed dramatic effects of the SAFE Pilot Project in the intervention areas on the improvement in latrine use, water use, hand-washing behaviour, and environmental sanitation. There was little change in the control areas. Two-week and 24-hour diarrhoea prevalence rates in children below 5 years of age decreased by almost two-thirds in the intervention areas compared to the control areas. Conclusions: These results show that the SAFE approach to hygiene behaviour change can have significant beneficial effects on knowledge and behaviour, as well as on risk of diarrhoea in children. Where prevention of diarrhoea is the concern, programmes and policies should focus on the identification of locally important risk behaviours and locally developed, and locally appropriate, interventions, rather than general messages and hardware targets. *CARE Bangladesh